Clinical Services Coordinator, Intermediate

Blue Shield of California • Full-time • California, United States, US • $20 - $28 / hour • 2d ago

Job Description

Your Role

The MCS Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Requests. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor of Clinical Services Intake . In this role you will be for supporting clinical staff day to day operations for Promise (Medi-Cal) or Commercial/Medicare lines of business

Your Work

In this role, you will:

Work in a production-based environment with defined production and quality metrics.
Process Faxed /Web Portal /Phoned in Prior Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.
Select support for Case Manager such as mailings, surveys.
Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
Support to Advanced/Specialist CSC.
Assign initial Extension Of Authority (EOA) days, or triage to nurses, based on established workflow.
Research member eligibility/benefits and provider networks.
Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.
Assists with system letters, requests for information and data entry.
Provides administrative/clerical support to medical management.
Intake (received via fax, phone, or portal). Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
Provide workflow guidance to offshore representative.
Other duties as assigned.

Qualifications

Your Knowledge and Experience

Requires a high school diploma or equivalent
Requires at least 3 years of prior relevant experience
May require vocational or technical education in addition to prior work experience
1-year work experience within the Medical Care Solutions’ Utilization Management Department or a similar medical management department at a different payor, facility, or provider/group.
In-depth working knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the Outpatient, Inpatient, DME and/or Home Health, Long Term Care and CBAS areas
In-depth working knowledge of the systems/tools utilized for UM authorization functions such as AuthAccel, Facets, PA Matrix or other systems at a different payor, facility, or provider/group.
Ability to provide both written and verbal detailed prior authorization workflow instructions to offshore staff.
Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.
Knowledge of UM regulatory Turn Around Time (TAT) standards
Knowledge of clinical workflow to assist nurses with case creation, research/issue resolution and other UM related functions, as necessary.

Pay Range

The pay range for this role is: $ 20.47 to $ 28.66 for California.

Note

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

About The Team

Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

Hybrid – In a business unit approved office a few times per year to 3 days per week, on average
Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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