Clinical Support Specialist

Responsibilities

• Affords administrative support to assigned clinical team, as directed by the Team Lead and/or Manager.
• Performs administrative tasks that support clinical processes (e.g. UM, CM, PHM), including but not limited to building medical management records (e.g. authorizations and referral management), compliance report monitoring, and completion of member/provider communications.
• Accurately documents all interventions in the member’s medical management record in accordance with established policies and procedures.
• Participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
• Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members to support collaborative medical management functions.
• Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training.
• Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes.
• Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training.
• Identifies opportunities and proposes alternatives for improving the Population Management functions.

Qualifications

• Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department.
• High School Diploma required. Continued higher education preferred.

Skills

• Strong organizational and time management skills.
• Demonstrated strong attention to detail and accuracy.
• Ability to follow job responsibilities as outlined in departmental policies and procedures.
• Excellent written and oral communication skills.

About the Role

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.