Vacancy expired!
Job Description
Day to Day Responsibilities of this Position and Description of Project: Position Summary : Clinical Services Coordinator - Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. Assists in ensuring members are effectively and efficiently managed through the medical/disease management process as needs require. Supports the Billing and Coding cycles for providers, coordination of benefits for patients, and processes claims accordingly. Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME. Process authorization requests and facilitates referrals. Assists with system letters, requests for information and data entry. Provides administrative/clerical support to medical and disease management. Provides support for lower level staff. Specific Responsibilities Include: Resource/educator for all team on billing, coding and encounter data. Maintains timeliness and accuracy requirements for encounters. Handle customer/provider problematic calls. Works directly with providers to ensure coding is captured accurately and represents the member visit. Special projects. Assist with process and system related issues; Develop and implement solutions, as necessary Intervene when precepting becomes problematic for Advanced CSC Back up to phones when needed. Other duties as assigned. Works to achieve operational targets within job area which has some impact on the overall achievement of broader team results. Works independently with minimal supervision. Work typically consists of tasks that are not routine, that require some discretion within broad operational boundaries and procedures. Operational targets may be achieved through leading other team members within the job area through delegation and review or through individual execution. Responsible for adjusting or recommending enhancements in systems and processes to solve problems or improve effectiveness of job area. Problems and issues faced are general, and may require understanding of broader set of issues, but typically are not complex. Problems may require understanding of other job areas. Problems are typically solved through drawing from prior experiences, with analysis of the issue. Communicates with contacts typically within and outside the department on matters that involve obtaining or providing information on matters of significant importance to the job area. Explains practices, procedures and policies to reach agreement. Other duties as assigned Office Environment- Roles involving part to full time schedule in office environment. Based in our physical offices and work from home office/deskwork- Activity level: Sedentary, frequency most of the workday. #LI-DNPVacancy expired!