Clinical Services Coordinator, Intermediate

Your Role

The MCS Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Request. The Clinical Services Coordinator 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 lines of business.

Your Work

In this role, you will:

• Process Faxed /Web Portal /Phoned in Authorizations Request, UM/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 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.
• Essential 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 representatives
• Other duties as assigned

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 preferred
• In-depth working knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the Inpatient, DME and/or Home Health, Long Term Care and CBAS areas preferred
• In-depth working knowledge of the systems/tools utilized in the UM authorization functions such as AuthAccel, Facets and PA Matrix preferred
• 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 TAT standards preferred
• Knowledge of clinical workflow to assist nurses with case creation, research/issue resolution and other UM related functions, as necessary preferred