Clinical Support Specialist
About The Position
Provides essential clinical and administrative support within a medical management environment, ensuring efficient case processing, accurate documentation, and regulatory compliance. Prepares and organizes medical records, reviews case management referrals, and coordinates with providers to gather necessary clinical information. Serves as a key liaison between healthcare providers and internal teams, manages appeals, facilitates communication, and ensures timely handling of cases in accordance with regulatory guidelines. Additionally, supports operational efficiency by managing work queues, assists with audits and quality improvement initiatives, identifies opportunities to streamline workflows and supports the department in clinical reviews and documentation. Actively participates in team collaboration, training, and ongoing education.
Requirements
- High school graduate or the equivalent with GED
- Completed one of the following formal education programs: Medical Assistant program that meets certification eligibility requirements; State approved Certified Nursing Assistant Program; or graduate of a school of nursing
- Hold a current certification or licensure as a Medical Assistant (MA), Certified Nursing Assistant (CNA), or Licensed Practical/Vocational Nurse (LPN/LVN)
- Strong attention to detail is required to maintain accurate documentation and uphold compliance with standards such as HIPAA, URAC, NCQA, and CMS
- Knowledge of medical terminology required
- Working knowledge of Microsoft Office software required
- Strong organizational and multitasking skills required
Nice To Haves
- Experience in health plan operations, TPA environments, case management, utilization review, or medical claims strongly preferred
- Experience working with medical records and clinical documentation preferred
- Experience communicating with providers and healthcare stakeholders preferred
- Experience with medical management systems preferred
- Additional certifications may be required based on department needs
Responsibilities
- Prepares and organizes medical records
- Reviews case management referrals
- Coordinates with providers to gather necessary clinical information
- Serves as a key liaison between healthcare providers and internal teams
- Manages appeals
- Facilitates communication
- Ensures timely handling of cases in accordance with regulatory guidelines
- Manages work queues
- Assists with audits and quality improvement initiatives
- Identifies opportunities to streamline workflows
- Supports the department in clinical reviews and documentation
- Actively participates in team collaboration, training, and ongoing education
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
