Address
Form of workA large managed care organization has a Full-time CONTRACT Position for a Clinical Administrative Coordinator Must have experience!
Must have one to two years of related work experience, including data entry along with excellent communication skills, and professional demeanor. Interact with internal and external customers in a courteous manner in person and via telephone.
- PAY: $22.00 per hour
- CONTRACT: Contract 11/06/2023 to 02/02/2024
- HOURS: Mon-Fri 8am-5pm PST
- LOCATION:Remote
Job Function Description
Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the
admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls,
managing requests for services from providers/members, providing information on available network services and transferring
members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior
authorizations. This function includes intake, notification and census roles. *Employees in jobs labeled with 'SCA' must support a
government Service Contract Act (SCA) agreement.
General Job Profile
- Extensive work experience within own function.
- Work is frequently completed without established procedures.
- Works independently.
- May act as a resource for others.
- May coordinate others' activities.- Extensive work experience within own function.
- Applies knowledge/skills to a range of moderately complex activities.
- Demonstrates great depth of knowledge/skills in own function.
- Sometimes acts as a technical resource to others in own function.
- Proactively identifies solutions to non-standard requests.
- Solves moderately complex problems on own.
- Works with team to solve complex problems.
- Plans, prioritizes, organizes and completes work to meet established objectives.
- May coordinate work of other team members.
Not Applicable
Minimum Educational Background
- High school education or equivalent experience.
Functional Competency & Description Proficiency Level
CLA_Receive Medical/Behavioral/Clinical Services or Benefits Requests C) Fully Proficient
- Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
- Extract and review fax requests for medical or clinical services
- Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
- Receive electronic referral form requests for medical/behavioral/clinical services
- Utilize phone system to respond to and transfer calls to appropriate individuals
- Ask callers standard questions to understand requests, gather necessary information, and assess urgency
- Access electronic member files using policy or id number
- Determine member eligibility
- Follow protocols to task requests appropriately
- Check procedure codes against notification requirements and benefit coverage to determine next steps
- Reference automated job aid tools via the computer to identify appropriate procedures when needed
Re
C) Fully Proficient
- Access claims information
- Review and interpret call history documentation (e.g., case notes)
- Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)
- Take calls and questions from members and/or providers regarding case status
- Determine whether authorizations are required for requested medical services
- Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
- Learn computer system and process changes and updates and incorporate into daily work
- Contact internal resources if necessary to clarify information
- Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests
Job Profile: Clin Admin Coord Sr-24
Page 2 of 2 Printed on: 11/2/2023
- Provide/explain benefit information to members/providers
- Provide/explain authorization information to members/providers
- Communicate with clinical team to ensure provider receives a response when necessary
- Document call history information into relevant computer system
- Enter medical request data into relevant computer system
- Follow standard procedures to complete requests
- Request medical review via relevant computer system as needed
- Review and advise member/provider of status of a request (e.g., notification, authorization)
- Schedule appointments for members based on request
- Provide information regarding appointments and medical services to facilities staff to assist members
What are the hours? ( Training hours?) - 8am-5pm PST
Will you be interviewing (face to face or phone) – virtual video
Please confirm the worksite location - remote
