What You'll Be Doing
The assignments performed by a Clinical Support Coordinator are structured in the main support functions listed below:
Triaging
• Triage phone calls from members, vendors, agencies, and staff - including urgent communications
• Triage documents: scanning, faxing, sorting, and assigning documents to staff, or department work queue to be followed up in the appropriate Electronic Medical Record (such as eClinicalWorks, EPIC, CIS, Athena, etc.) and/or Care Management Platform (Guiding Care) - including urgent communications
• Triage and distribute tasks to interdepartmental workgroups/staff within the appropriate Electronic Medical Record and/or Care Management Platform per guidelines established by leadership
Authorizations
• Provide accurate, prompt, and appropriate entry of medical referrals and requests from CCA clinicians, members, vendors, and/or providers for services needing prior authorizations
• Ensure submission of information needed for completion of service decision requests based as validated and instructed by clinical staff
• Provide clear and accurate documentation of all communication and activities
• Handle all requests timely and accurately, adhering to performance and compliance measures
Fulfillment
• Place orders with vendors based on clinical staff and/or member requests for supplies, equipment, and/or services
• Coordinate procurement of support services in the community authorized by clinical staff
• Follow-up on order accuracy, timeliness, and delivery/shipment of goods and services, as well as member outreach to confirm the appropriateness of the order and/or service provided
• Manage exceptions and substitutions. Work to resolve problems
• Ensure closed loop communication processes
Data Integrity
• Update and maintain data in multiple Electronic Medical Records (internal and external), Care Management Platform (Guiding Care), and Enrollment Platform (Market Prominence) with accurate information regarding clinical care team, support service agency assignment, and member demographics
• Reconcile data displayed in multiple Electronic Medical Records (internal and external) and Care Management Platform to ensure accurate data on reporting for managerial, operational, and financial purposes
Scheduling
• Schedule home visits for clinicians such as Annual Comprehensive Assessments (ACA), SCO Personal Care Attendant (PCA) Evaluations, Minimum Data Set Assessments (MDS), Pharmacy Medication Management visit.
• Document scheduling attempts
• Place reminder calls for scheduled visits
Additional duties as requested by supervisor.
What We're Looking For
Required Qualifications
Associate degree or at least 2+ years of applicable experience
2+ years office/administration experience
Basic arithmetic skills
Proficiency in Microsoft Office Suite
Preferred Qualifications
Bachelor’s degree
Experience working in a health plan, medical group, health-related facility or medical/DME supplier
Education, training or experience as an insurance coordinator or medical coder/biller
Knowledge of medical terminology
Working knowledge of CPT and ICD coding
Experience with Electronic Medical Records and/ or Care Management Platform
Bilingual
Commonwealth Care Alliance
Springfield Massachusetts
United States
Healthcare - Physician
(No Timezone Provided)
What You'll Be Doing
The assignments performed by a Clinical Support Coordinator are structured in the main support functions listed below:
Triaging
• Triage phone calls from members, vendors, agencies, and staff - including urgent communications
• Triage documents: scanning, faxing, sorting, and assigning documents to staff, or department work queue to be followed up in the appropriate Electronic Medical Record (such as eClinicalWorks, EPIC, CIS, Athena, etc.) and/or Care Management Platform (Guiding Care) - including urgent communications
• Triage and distribute tasks to interdepartmental workgroups/staff within the appropriate Electronic Medical Record and/or Care Management Platform per guidelines established by leadership
Authorizations
• Provide accurate, prompt, and appropriate entry of medical referrals and requests from CCA clinicians, members, vendors, and/or providers for services needing prior authorizations
• Ensure submission of information needed for completion of service decision requests based as validated and instructed by clinical staff
• Provide clear and accurate documentation of all communication and activities
• Handle all requests timely and accurately, adhering to performance and compliance measures
Fulfillment
• Place orders with vendors based on clinical staff and/or member requests for supplies, equipment, and/or services
• Coordinate procurement of support services in the community authorized by clinical staff
• Follow-up on order accuracy, timeliness, and delivery/shipment of goods and services, as well as member outreach to confirm the appropriateness of the order and/or service provided
• Manage exceptions and substitutions. Work to resolve problems
• Ensure closed loop communication processes
Data Integrity
• Update and maintain data in multiple Electronic Medical Records (internal and external), Care Management Platform (Guiding Care), and Enrollment Platform (Market Prominence) with accurate information regarding clinical care team, support service agency assignment, and member demographics
• Reconcile data displayed in multiple Electronic Medical Records (internal and external) and Care Management Platform to ensure accurate data on reporting for managerial, operational, and financial purposes
Scheduling
• Schedule home visits for clinicians such as Annual Comprehensive Assessments (ACA), SCO Personal Care Attendant (PCA) Evaluations, Minimum Data Set Assessments (MDS), Pharmacy Medication Management visit.
• Document scheduling attempts
• Place reminder calls for scheduled visits
Additional duties as requested by supervisor.
What We're Looking For
Required Qualifications
Associate degree or at least 2+ years of applicable experience
2+ years office/administration experience
Basic arithmetic skills
Proficiency in Microsoft Office Suite
Preferred Qualifications
Bachelor’s degree
Experience working in a health plan, medical group, health-related facility or medical/DME supplier
Education, training or experience as an insurance coordinator or medical coder/biller
Knowledge of medical terminology
Working knowledge of CPT and ICD coding
Experience with Electronic Medical Records and/ or Care Management Platform
Bilingual