Clinical Intake Correspondence Specialist

Cambia • Spokane, WA

417d • Remote

About The Position

The Clinical Intake Correspondence Specialist plays a crucial role in supporting Cambia's mission to enhance healthcare accessibility and improve lives. This position involves receiving, researching, and taking initial actions on documentation and requests related to Utilization Management (UM), Care Management (CM), and Disease Management (DM) programs. While the specialist does not make clinical decisions, they collaborate with licensed health professionals to ensure appropriate actions and responses are taken.

Requirements

• High school diploma or GED.
• 3 years of healthcare background, customer service experience, or 3 years of clinical services experience, or an equivalent combination of education and experience.
• Effective communication and writing skills.
• Strong customer service skills, including listening, patience, empathy, and maintaining confidentiality.
• Intermediate computer skills (e.g., Microsoft Office, Outlook, Internet search) and experience with healthcare systems and documentation (EMR, billing, and claims).
• Strong organization, data entry, and administrative skills.
• Demonstrated knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs).
• Knowledge and understanding of clinical services department programs (UM, CM, DM) and operations.
• Ability to investigate and research issues related to clinical programs and work with clinical staff to resolve them.
• Ability to work independently, prioritize work, meet deadlines, and achieve operational standards.
• Ability to work effectively in a team environment.

Responsibilities

• Adhere to dependability, customer focus, and performance criteria established by the department, including timeliness, production, and quality standards.
• Utilize knowledge to research documentation and requests related to UM processes and CM and DM programs from various stakeholders.
• Review requests for completeness and identify additional information needed to initiate the request, asking for it when appropriate.
• Validate preauthorization requirements, member benefits, eligibility, and document information in the appropriate system.
• Create cases for UM, CM, DM in the Care Management System as appropriate and may administratively authorize services as directed by Clinical Services Management.
• Coordinate case information in external vendor systems for Medical Director Reviews as necessary.
• Receive medical inpatient admission and discharge notifications and document them for UM and CM use.
• Coordinate reviews with members, providers, clinical staff, other departments, and vendors to process requests and provide complete responses.
• Follow strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality, and compliance with regulations.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED