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 timely processing. This role involves administrative support, monitoring queues, and assisting with medical records to enhance operational efficiency.
Key Responsibilities
Process faxed/phoned in authorizations and requests
Monitor specific queues/workstreams and generate reports
Handle customer/provider problematic calls
Check member history for case management triage
Assign initial EOA days or triage to nurses
Assist with system letters, requests for information, and data entry
Monitor for Medical Records Outstanding (MRO)
Provide administrative/clerical support to the FCR team
Act as a liaison for care management programs
Work on projects with the Operations Specialist and Senior Manager