Health Services Clinical Support Specialist (Remote eligible after training)

Wellmark, Inc. • Des Moines, IA

1d • Hybrid

About The Position

You will provide daily support to Wellmark care management team members through making outbound calls to clinical staff regarding denials for services and admissions, as well as scheduling peer to peer reviews for Medical Directors. In this role, you will complete prompt and professional outbound phone and fax inquiries to obtain member discharge dates. You will also support and request clinical information as directed by the Utilization Management Nurses. On occasion, you will also provide backup for other Health Services team members as needed. Critical thinking and adaptability to change is critical in this fast-paced position.
About You: Are you excited about the opportunity to advocate for stakeholders through collaboration with multi-disciplinary teams? Are you able to manage a large variety of responsibilities while staying organized? Do you have a high attention to detail and are thorough in your work? If you are a dedicated, customer-focused health care professional motivated and inspired by the opportunity to provide administrative support to care management teams in a fast-paced environment, apply today!
This role will require training for the first 4 weeks from our Des Moines, Iowa office. After a successful training period, you will have the option to work remote every day, or a hybrid office/home schedule based on your preference. Work hours will be from Monday through Friday from 8:30 AM - 5:00 PM Central Time.

Requirements

• High School Diploma or GED.
• 1+ years of related experience in health insurance or health care industry experience with knowledge of health insurance terminology and medical coding, including the ability to translate jargon and abbreviations to medical language.
• Experience producing medical reports, correspondence, records, patient care information, statistics, medical research and/or administrative material.
• Strong written and verbal communication skills with the ability to communicate complex concepts clearly and concisely to stakeholders.
• Proficiency with Microsoft Office applications.
• Experience working in a team environment.
• Experience establishing relationships and effectively engaging with members and providers by demonstrating active listening skills through telephonic communication to obtain necessary information.
• Ability to work in a fast-paced environment where production and/or quality goals are measured.
• Demonstrated commitment to timeliness, prioritization, accuracy, and attention to detail.

Nice To Haves

• Prior remote work experience in a fast-paced environment.

Responsibilities

• Support clinical staff by assisting them with gathering data to complete the medical necessity review process. Complete outbound inquiries via phone/fax to obtain discharge dates, and/or to request clinical information as directed by the Care Coordination Nurses.
• Create and send letters to providers and/or members to communicate information.
• Work in collaboration with other care management teams and stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member.
• Meet both quality assurance and production metrics established by Health Services.
• Perform accurate, timely documentation of pertinent information as defined in department guidelines.
• Comply with regulatory standards, accreditation standards and internal guidelines; remain current and consistent with the standards pertinent to Health Services.
• Provide backup assistance to team members as needed.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees