Join Blue Shield of California as a Clinical Services Coordinator, Advanced, where you will assist the clinical team in reviewing facility compliance claims and ensuring timely processing. Your role will involve monitoring workflows, managing medical records, and providing vital administrative support to enhance operational efficiency.
Key Responsibilities
Process faxed/phoned in authorizations, UM/CM requests, and special processing/case types
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
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 on projects as assigned with the Operations Specialist and Senior Manager