Join Blue Shield of California as a Clinical Services Coordinator, Advanced and support the clinical team in timely reviews of facility compliance claims. Your role involves processing authorizations, managing queues, and providing administrative support while ensuring compliance with industry standards.
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), ensuring 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 care management programs
Work with the Operations Specialist and Senior Manager on projects as assigned