Join Blue Shield of California as a Clinical Services Coordinator, Advanced, where you'll support the clinical team in reviewing facility compliance claims and ensuring efficiency in operations. This role offers a unique opportunity to enhance your skills in a dynamic healthcare environment while making a meaningful impact on patient care.
Key Responsibilities
Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemail
Monitor specific queues/workstreams and generate pre-defined reports to identify and resolve common errors
Handle customer/provider problematic calls
Check member history for case management triage and research member eligibility/benefits and provider networks
Assign initial EOA days, or triage to nurses based on established workflow
Assist with system letters, requests for information and data entry
Monitor for Medical Records Outstanding (MRO) and ensure timely receipt and filing of medical records
Provide administrative/clerical support to the FCR team
Act as a liaison, gather information and track all patients referred to the care management programs
Work with the Operations Specialist and Senior Manager on assigned projects