Clinical Services Coordinator, Intermediate

About the 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 Operations Management Supervisor. In this role, you will answer a high-volume of inquiry calls and advise or request from doctor’s offices if prior authorization is required for a given service. You will also receive and process admits from hospitals when members are admitted to a facility, as well as process prior authorization fax requests.

Our leadership model focuses on developing great leaders at all levels and creating opportunities for personal, professional, and financial growth. We seek leaders energized by creative and critical thinking, building high-performing teams, achieving results ethically, and fostering continuous learning.

Responsibilities

• Answer a high volume of phone inquiries and load faxed authorizations
• Data entry including authorization forms, high-risk member information, and verbal HIPAA authorizations for case creation
• Support Advanced/Specialist Clinical Support Coordinators
• Assign initial estimated out-of-area (EOA) days or triage to nurses based on established workflow
• Research member eligibility, benefits, and provider networks
• Verify member eligibility
• Process hospital admits
• Send referrals to Case Management as appropriate
• Other duties as assigned

Requirements

• High school diploma or equivalent
• At least 3 years of prior relevant experience, preferably including answering a large volume of inbound calls
• Strong attendance record preferred
• Solid technical skills – ability to navigate Microsoft programs and learn in-house software
• Sharp communication and teamwork skills

Preferred Qualifications

• Experience within the Federal Employee Program (FEP) using AuthAccel
• Experience with medical coding (CPT/Dx)

Schedule

This role allows employees to work virtually full-time; however, employees will be expected to come to the office based on business need.

Locations

El Dorado Hills, CA | Long Beach, CA | Lodi, CA | Oakland, CA | Rancho Cordova, CA | Redding, CA | San Diego, CA | Woodland Hills, CA

Pay

• California: $21.73 to $30.43 per hour
• Bay Area: $24.50 to $34.31 per hour

Note: This range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Salaries are based on candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun, a nonprofit corporate entity that includes Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations form the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends—sustainably affordable. We are transforming healthcare by lowering costs, improving quality, and enhancing the member and physician experience. To achieve this, we foster an environment where all employees can thrive and contribute fully to the needs of the communities we serve.

Blue Shield is recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace. We were also recognized by Fair360 as a Top Regional Company and by Points of Light as one of the 50 most community-minded companies in the United States.

Our Values

• Honest: We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say and acknowledging and correcting where we fall short.
• Human: We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous: We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Workplace Model

We foster a workplace environment that balances purposeful in-person collaboration with flexibility. Our model is designed around intentional in-person interaction, collaboration, connection, creativity, and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office, out-of-state employees, and those in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions impacting their ability to work in-office, we engage in an interactive process to provide reasonable accommodations.

The Company reserves the right to require more in-office presence based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements

Office Environment – roles involving part- to full-time schedule in an office setting. Based in physical offices and work-from-home deskwork. Activity level: Sedentary, frequency most of the workday.