Clinical Support Specialist
Workplace Options is supporting Behavioral Health Systems (BHS) in recruiting a Clinical Support Specialist. BHS operates one of the nation’s largest specialty preferred provider organizations (PPO), comprising psychiatrists, psychologists, social workers, EAP providers, and facility networks including hospitals, rehab/residential treatment centers, partial hospitalization programs, and intensive outpatient programs. BHS fully credentials and panels its own network of providers.
About the role
The Clinical Support Specialist provides essential administrative support to the Clinical Services Division, ensuring efficient patient care operations and seamless coordination across TELUS Health departments and external provider networks. This role supports critical functions including claims processing, benefits verification, and provider network research.
Responsibilities
- Claims Review and Processing
- Review and verify incoming claims for accuracy and completeness using internal systems, cross-referencing both digital records and paper documentation.
- Research and correct returned claims for rate discrepancies or instruction errors; document findings in the claims management system and identify trends.
- Escalate unresolved or complex claims to assigned Care Coordinators with detailed claim history and recommended next steps; track resolution status.
- Eligibility And Benefits Verification
- Confirm patient coverage eligibility, including effective and termination dates, by accessing internal eligibility systems.
- Verify plan coverage details such as copays, coinsurance, deductibles, out-of-pocket maximums, and benefit accumulations.
- Document all benefit verification inquiries and findings in the patient intake system for record-keeping and auditing.
- Communicate verified benefit information to providers clearly and promptly to support accurate billing and patient communication.
- Follow up on pending benefit verification requests and provide status updates to maintain provider satisfaction.
- Escalate urgent or complex benefit-related issues to supervisors for immediate resolution.
- Provider Network Research and Development
- Research the TELUS Health provider network to identify and compile lists of provider options aligned with patient-specific needs, geographic preferences, and treatment requirements.
- Communicate network deficiencies and coverage gaps to the Provider Relations department; collaborate to ensure adequate network coverage.
- Submit patient-specific provider requests initiated through retrospective claims review, patient requests, and documented network deficiencies.
- Maintain organized records of provider research activities and network development initiatives.
- General Administrative Duties
- Maintain accurate, organized, and compliant documentation standards for all claims, benefits verifications, and research activities.
- Adhere to all TELUS Health policies, HIPAA regulations, and data security standards.
- Perform other related duties as directed by supervisory staff.
Requirements
- Bachelor's Degree in Psychology or another Mental Health-related field.
- 1-2 years of professional experience in healthcare, clinical, or insurance administration.
- Advanced organizational and time management skills with the ability to manage complex, multi-faceted priorities independently.
- Excellent written and verbal communication skills.
- Proficiency with Microsoft Office Suite and healthcare-related software systems.
- Demonstrated attention to detail and accuracy in data entry, analysis, and documentation.
- Professional demeanor and strong interpersonal skills.
- Commitment to maintaining strict patient confidentiality and HIPAA compliance.
Pay
$56,000 - $60,000 per annum.
Benefits
Competitive benefits offering.
Schedule
Full-time (40 hours per week).