Join Blue Shield of California as a Clinical Services Coordinator, Advanced, where you'll support the clinical team in reviewing facility compliance claims and ensure they have the necessary resources to complete medical necessity reviews. Your role involves processing authorizations, monitoring queues, and providing essential administrative support.
Key Responsibilities
Process faxed/phoned in authorizations, UM/CM requests, and special processing/case types
Monitor specific queues/workstreams and generate pre-defined reports
Handle customer/provider problematic calls
Check member history for case management triage and research member eligibility/benefits
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 to gather information and track patients referred to care management programs
Work with Operations Specialist and Senior Manager on assigned projects