Clinical Support Specialist
Capital Blue Cross
full-time
Posted on:
Location Type: Remote
Location: Remote • Pennsylvania • 🇺🇸 United States
Visit company websiteSalary
💰 $19 - $35 per hour
Job Level
JuniorMid-Level
About the role
- Provides administrative support to assigned clinical team, as directed by the Team Lead and/or Manager
- Perform administrative tasks that support clinical processes (e.g. UM, CM, PHM)
- Building medical management records (e.g. authorizations and referral management)
- Compliance report monitoring
- Completion of member/provider communications
- Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes
- Supports administrative functions with community events (e.g. health fairs)
- Accurately documents all interventions in the member’s medical management record
- Actively participates in supporting department compliance and performance
- Adheres to all regulatory and compliance standards
- Interacts courteously and professionally with customers
- Identifies and reports potential quality of service/care issues
- 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
- Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Comprehensive benefits packaging
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical management recordscompliance report monitoringmember/provider communicationsfax outreachtelephonic outreachwritten communicationspopulation management functionsmedical terminologyhealth plan benefitsregulatory standards
Soft skills
organizational skillstime managementattention to detailcommunication skillsprofessionalismcustomer serviceproblem identificationteam participationpersonal growthadaptability