Clinical Support Specialist

Blue Cross and Blue Shield Association • Harrisburg, PA

344d

About The Position

The Clinical Support Specialist provides administrative support to the assigned clinical team, as directed by the Team Lead and/or Manager. This role involves performing administrative tasks that support clinical processes, including building medical management records, compliance report monitoring, and completion of member/provider communications. The position is integral to ensuring effective communication and documentation within the clinical team, contributing to the overall mission of improving health and well-being.

Requirements

• Minimum 2 years' experience in the medical field (e.g. medical assistant, medical secretary) or 2 years' experience in a managed care clinical department.
• High School Diploma required.
• Working knowledge of medical terminology.
• Working knowledge of the health insurance industry, health plan benefits and product lines.
• Knowledge of regulatory and accreditation standards and requirements.

Nice To Haves

• Continued higher education preferred.

Responsibilities

• Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
• Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
• Supports administrative functions with community events.
• Accurately documents all interventions in the member's medical management record in accordance with established policies and procedures.
• Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution.
• Adheres to all regulatory and compliance standards, including adherence to all Capital and department specific policies and procedures.
• Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members.
• Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes.
• Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training.
• Identifies opportunities and proposes alternatives for improving the Population Management functions.

Benefits

• Medical, Dental & Vision coverage
• Retirement Plan
• Generous time off including Paid Time Off, Holidays, and Volunteer time off
• Incentive Plan
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: High school or GED