Clinical Support Associate- Pediatrics

TEKsystems•Santa Barbara, CA

2d•$23 - $26•Hybrid

About The Position

A Clinical Support Associate – Utilization Management Pediatrics (CSA – UM PEDs) is part of one of several Health Services clinical units, including Case Management, Care Coordination, Disease Management, or the Pediatric-Whole Child Model program. The CSA reports directly to the unit manager or their designee. In this role, the CSA provides essential coordination support for clinical teams, assists with daily operations, ensures timely work processes, and performs clerical tasks for the assigned unit. Strong written and verbal communication skills are crucial. The CSA is responsible for accurate and timely data entry and collection while interacting with CenCal Health employees, providers, and members. Depending on the unit, and under the supervision of the manager or their designee, the CSA may manage authorization and referral requests, conduct health surveys with members, and follow up with members requiring periodic telephonic outreach. The CSA will be primarily assigned to the Pediatric unit.

Requirements

Ability to work independently, follow instructions with minimal supervision, and collaborate effectively as part of an interdisciplinary team
Receptive to constructive feedback and committed to personal and professional growth
Strong organizational and multitasking abilities
Knowledge of basic medical terminology, billing (CPT), and diagnosis coding (ICD-10)
Ability to maintain member confidentiality and comply with HIPAA regulations
Exceptional attention to detail with a focus on accurate and clear record-keeping
Ability to complete tasks within required regulatory timelines
Minimum typing speed of 35 words per minute
Ability to work effectively with individuals from diverse backgrounds and educational levels
Proficiency in drafting clear, concise, and grammatically correct correspondence
Basic knowledge of Medi-Cal and its covered services
Familiarity with health-related community-based organizations, healthcare delivery systems, and resources for low-income and elderly populations
A minimum of 12 months of full-time or equivalent experience in a medical office, health plan, managed care organization, hospital (ED or inpatient), skilled nursing facility, clinic, or another healthcare setting, working directly with patients, members, providers, and/or clinicians
Successful completion of an accredited Medical Assistant or Medical Office Professional program may substitute for six (6) months of work experience

Nice To Haves

Bilingual in Spanish (required for specific positions outside of Utilization Management)

Responsibilities

Respond promptly to inbound calls in the Health Services phone queues
Make outbound calls to providers, members, and CenCal Health staff regarding operational processes
Report any conflicts or challenges with members or providers to the supervisor promptly
Ensure the confidentiality and privacy of member information, adhering to HIPAA and confidentiality regulations
Follow CenCal Health’s mission, protocols, policies, and procedures while meeting performance standards
Attend company-wide and departmental meetings and training sessions on time, actively participating as appropriate
Respond promptly, professionally, and courteously to emails, phone calls, and other forms of communication
Interact professionally with CenCal Health employees, members, and providers
Perform other duties as assigned by the supervisor