Clinical Training and Auditing Coordinator, Intermediate

Blue Shield of CaliforniaEl Dorado, AR
3d

About The Position

Your Role The Clinical Training & Auditing team is in place to ensure the provision of care rendered to our most vulnerable population is safe and of quality, by DHCS standards. The Facility Site Review (FSR) team will report to the Clinical Access Program leadership. In this role you will assess all work in a manner that supports the established county collaboration and statewide expectations that PCPs adhere to appropriate local, state, and federal laws and regulations. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

  • Requires at least 3 years of prior relevant experience.
  • Excellent telephone and email etiquette skills
  • Proven Time Management and organizational skills
  • Strong detail oriented and quality focused skills

Nice To Haves

  • Knowledge of Healthy Data Systems (HDS) is preferred but not required
  • Knowledge of Provider Manager (PIMS) is preferred but not required

Responsibilities

  • Assist in the collection, tracking, and submission of clinical review documentation
  • Make outbound calls to providers, conduct follow-up and tracking of audit documentation
  • Perform data entry of provider and audit information with various notes into our data system and trackers
  • Upload documents to data system in a timely and accurate manner
  • Complete faxes and emails to provider offices and internal business partners
  • Support the Clinical Access Program team and leadership with various administrative duties, report validation, and escalations related to various audits
  • Participate in the preparation of annual audit by way of research and validation
  • Help to manage assigned email box inquiries and tasks
  • Assist with desk level procedure creation, testing, and revisions
  • Participate in cross-training efforts until all Coordinator tasks are cross-functional
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