Clinical Support Specialist
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Job Description
Clinical Support Specialist providing administrative support to assigned clinical teams at Capital Blue Cross. Involved in medical management processes and community events coordination.
Responsibilities:
- Provides administrative support to assigned clinical team, as directed by the Team Lead and/or Manager
- Assist with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes (e.g. UM, CM)
- Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes (e.g. verbal notification, engagement status, discharge plan)
- Supports administrative functions with community events (e.g. health fairs)
- Accurately documents all interventions in the member’s medical management record in accordance with established policies and procedures
- Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership
- Adheres to all regulatory and compliance standards, including adherence to all Capital and department specific policies and procedures
- Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members to support collaborative medical management functions
- Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes
- Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training
- Identifies opportunities and proposes alternatives for improving the Population Management functions
Requirements:
- Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department
- Strong organizational and time management skills
- Demonstrated strong attention to detail and accuracy
- Ability to follow job responsibilities as outlined in departmental policies and procedures
- Excellent written and oral communication skills
- Working knowledge and operation of a personal computer, including proficiency in Microsoft Office applications
- Working knowledge of medical terminology
- Working knowledge of the health insurance industry, health plan benefits and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive)
- Knowledge of regulatory and accreditation standards and requirements (e.g. NCQA, CMS)
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Comprehensive benefits packaging
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