Clinical Support Specialist (69377)

Summary Of Duties And Responsibilities

Provides clinical support in key functions such as prior authorizations, equipment orders (DME), and other duties that support key clinical workflows in the delivery of patient care. Ensures efficient processes are in place, for example, communication and authorizations are obtained to continue delivery of care.

Primary Duties And Responsibilities

• Assists healthcare providers in obtaining approvals by payors in areas such as medications, prior authorizations of procedures and medical equipment.
• Manages the providers documents to ensure key actions are taken to obtain medication Prior Authorizations, DME equipment, or medical procedures.
• Reviews key documentation in patients' medical record to obtain clinical information pertinent to obtain approval.
• Accesses key databases such as Cover My Meds, OptumRx to obtain approvals and payor websites needed to receive approvals.
• Proficient in EPIC charting, documentation, in-basket management, WQ management.
• Contacts outside agencies and patients to ensure that appropriate patient care is completed.
• Contacts patients to schedule follow up appointments after approvals are obtained and communicates any payment responsibility on their behalf.
• Keeps patients informed of progress or if any additional requests are needed for approval.
• Communicates with providers and medical support team on progress or additional documentation required.
• Maintains confidentiality of patient information in accordance with HIPAA regulations.
• Supports clinic operations during provider absences or high-volume periods.
• Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable.
• Provides leadership and work with all staff to achieve the goals of the “Quintuple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.
• Embolizes the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment.
• Must be a leader in the department and community.
• Result-oriented problem solver who is responsible and accountable.

Qualifications

• High School Diploma or GED.
• Medical Assistant Certification or one (1) or more years of equivalent experience.
• Experience across more than one service line and the ability to independently manage assigned clinical workflows with minimal supervision.
• Proficient in Medical Assistant core competencies.
• Must complete and pass CPR course within 90 days of employment.
• Ability to travel 15% or more within state between clinics.
• Proficient computer skills, including data entry and typing.
• Knowledge of instrumentation used in lab point of care testing, as directed, within 90 days.
• Able to lift a minimum of 25 pounds.
• Able to sit for long periods of time.