Clinical Services Coordinator, Advanced

Your Role The Facility Compliance Review (FCR) team reviews postservice prepayment facility claims for contract compliance,industry billing standards, medical necessity and hospital acquiredconditions The Clinical Services Coordinator, Advanced will reportto the Manager, Operations FCR. In this role you will assist theclinical team to ensure a timely review of facility complianceclaims, including monitoring queues, assisting with administrativesupport to the FCR team This will include management of dailyinventory, assisting with researching claims, pulling medicalrecords and answering questions sent to the FCR mailbox. The maingoal of this team is to support the clinical team to ensure theyhave what they need in order to complete the medical necessityreviews. Your Work In this role, you will: Process faxed/phoned inauthorizations, UM/CM requests, special processing/case typesand/or calls left on voicemail Monitor specific queues/workstreamsand generates pre-defined reports to identify and resolve commonerrors Handle customer/provider problematic calls Check memberhistory for case management triage and research membereligibility/benefits and provider networks Assign initial EOA days,or triage to nurses, based on established workflow Assists withsystem letters, requests for information and data entry. Monitorsfor Medical Records Outstanding (MRO), keeps track to ensure timelyreceipt and filing of medical records. Requires occasional visitsto the office to collect these medical records. Providesadministrative/clerical support to the FCR team. Acts as a liaison,gather information and track all patients referred to the caremanagement programs Work with the Operations Specialist and SeniorManager on projects as assigned. Monitor specificqueues/workstreams and generates pre-defined reports to identifyand resolve common errors. Your Knowledge and Experience Requires ahigh school diploma or equivalent Requires at least 5 years ofprior relevant experience Requires health insurance/managed careexperience Requires strong computer navigation skills Requiresindependent motivation and strong work ethic