Clinical In-take Specialist

Blue Cross Blue Shield of Massachusetts • Hingham, MA

8d • Onsite

About The Position

The Clinical Intake Specialist (Customer Service) is an integral part of Utilization Management, processing telephonic and fax notifications, referrals, and requests for authorization from members, facilities, and physician offices. The Clinical Intake Specialist (Customer Service) utilizes organizational and communication skills, principals of managed care, knowledge of regulatory requirements, and collaborative interactions with the clinical reviewers and provider community to facilitate efficient and timely requests. The Clinical Intake Specialist (Customer Service) focuses on building and updating referrals and authorization requests in the member record that are essential to conducting the review process and enabling accurate and timely claims payment. The Clinical Intake Specialist (Customer Service) works primarily by fax and telephone to ensure that all necessary information is received so that an optimal review can be conducted by a team clinician. The Clinical Intake Specialist (Customer Service) demonstrates an understanding of regulatory requirements, principals of managed care and department business goals and objectives.

Requirements

• HS Diploma/GED, required
• Excellent attendance, punctuality & professionalism
• Must be comfortable working in a high volume & fast paced call center environment
• Must be able to answer calls/faxes, inquiries & requests with a sense of urgency
• Superb attention to details & be able to meet deadlines
• Previous experience in a medical/clinical setting, preferred
• Proficiency in Microsoft Office/computer programs; Must be Tech Savvy!

Nice To Haves

• Associate's degree, preferred
• Customer service training or previous Call Center experience, highly desired
• Knowledge in DRG assignment, Human Anatomy/Physiology/Clinical Disease Processes or Medical Terminology is strongly preferred
• Strong communication, telephone & writing skills

Responsibilities

• Verify member eligibility, collect demographic and pertinent clinical information, and document results in the computer system
• Build cases in the computerized member record using information gathered from faxes and/or phone calls
• Document of information using department standards of documentation
• Communicate with providers regarding the assigned DRG, and/or any necessary decision data
• Assign accurate codes to all diagnoses and procedures and the DRG, recoding, and updating cases when applicable
• Communicate with the Clinical Review team to ensure continuity of the notification, coding, and review processes
• Manage of workload within regulatory turnaround time requirements and mandated timeframes for processing cases
• Handle protected health information consistent with department and company policies and regulatory requirements
• Assist in refinement and implementation of unit workflows to enhance efficiency and support unit/department goals
• Assist implementation of all new utilization management processes and programs in accordance with business plans to provide quality customer service to all customers
• Engage in cross-training to develop the variable skills necessary to support all team responsibilities
• Other duties as assigned

Benefits

• 100% eligibility on BCBSMA's Benefit & Wellness Plans
• Required 90-Day Training Program
• Free parking on our Quincy campus!
• Full support and engagement from a dedicated & dynamic team of leaders & peers
• Professional development & career opportunities at BCBSMA after 12 months of service
• paid time off
• medical/dental/vision insurance
• 401(k)
• a suite of well-being benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED