Your Role
The Medical Care Solutions Federal Employee Program team provides Prior Authorization and Utilization Management services to our members. The Clinical Support Coordinator will report to the Non-Clinical Operations Manager. In this role you will be responsible for a combination of answering a high-volume of inquiry calls, receiving and processing admits from hospitals when members are admitted to a facility, receiving and loading Prior Authorization requests into in-house computer software, and other duties as assigned.
Your Work
In this role, you will:
Answer a high volume of phone inquiries and load faxed authorizations
Data entry including prior authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
Support to Advanced/Specialist CSCs
Assign initial EOA days, or triage to nurses, based on established workflow
Select support for Case Manager such as mailings, surveys
Research member eligibility/benefits and provider networks
Verify member eligibility
Process hospital admits
Send referrals to Case Management as appropriate
Other duties as assigned
Your Knowledge and Experience
Requires a high school diploma or equivalent
Requires at least 3 years of prior relevant experience
Prefers strong attendance record
Prefers solid technical skills – ability to navigate MS programs and learn in-house software
Prefers sharp communication and teamwork skills
Preferred – experience within FEP using AuthAccel and FEP Direct
Preferred – experience with medical coding - CPT/Dx
Salary Range
The pay range for this role is: $ 20.47 to $ 28.66 for California.
Note
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.