Clinical Services Coordinator, Intermediate

4 weeks ago


California, United States Blue Shield of California Full time

About the Role

The Blue Shield of California team is seeking a skilled Clinical Services Coordinator, Intermediate to join our Children's Health Program (CHP) team. As a key member of our team, you will play a critical role in providing identification, referrals, and care management for all Medi-Cal members under the age of 21.

Key Responsibilities

  • Process and manage faxed and phoned-in authorizations, UM/CM requests, and voicemails in a timely and efficient manner.
  • Support Case Managers with mailings, surveys, and other administrative tasks.
  • Enter data into our system, including authorization forms, high-risk member information, and verbal HIPAA authorizations for case creation.
  • Collaborate with Advanced/Specialist CSCs to ensure seamless support.
  • Assign initial EOA days or triage to nurses based on established workflow.
  • Research member eligibility, benefits, and provider networks to ensure accurate and timely support.
  • Provide operational support to ensure healthcare services are provided to members, employers, and providers.
  • Serve as the initial point of contact for members and providers by telephone or correspondence.
  • Review and process service authorization referrals and assist with system letters, requests for information, and data entry.
  • Provide administrative and clerical support to medical management teams.

Requirements

  • Strong communication and interpersonal skills.
  • Ability to work in a fast-paced environment with multiple priorities.
  • Proficiency in data entry and management systems.
  • Excellent organizational and time management skills.
  • Ability to maintain confidentiality and handle sensitive information.


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