Description: Your Role
The Medical Care Solutions Federal Employee Program team provides prior authorization and utilization management services to our members. The Clinical Support Coordinator will report to the Operations Manager.
Your Work
In this role, you will:
•Answer a high volume of phone inquiries and load faxed authorizations
•Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
•Support to Advanced/Specialist CSC
•Assign initial EOA days, or triage to nurses, based on established workflow
•Select support for Case Manager such as mailings, surveys
•Research member eligibility/benefits and provider networks
•Verify member eligibility
•Process hospital admits
•Send referrals to Case Management as appropriate
•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
•Requires strong attendance record
•Requires solid technical skills – ability to navigate MS programs and learn in-house software
•Requires sharp communication and teamwork skills
•Preferred - experience with medical coding - CPT/Dx
Top 3 Required Skills
Strong computer skills including
MS based programs, Solid work ethic,
Strong communicator
Preferred/nice to have skills
Solid attendance record, team player, quick learner. Experience in healthcare industry, especially as Medical Assistant, front office work at doctor office. Call center/data entry experience.
Software Skills Required
Value: Ability to effectively use Windows based PC with 2 screens, learn in-house software, and navigate using multiple programs at once.