[Hiring] Clinical Support Specialist @Capital Blue Cross

Role Description

Provides administrative support to assigned clinical team, as directed by the Team Lead and/or Manager. The Clinical Support Specialist will perform administrative tasks that support clinical processes (e.g. UM, CM, PHM), including but not limited to:

• Assists 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.

Qualifications

• 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.

Requirements

• 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).
• Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department.
• High School Diploma required.
• Continued higher education preferred.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.