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Clinical Services Coordinator, Advanced

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: September 18, 2022

Job Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to DE&I combines a focus on our people processes and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen. Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us Your Role The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions The Clinical Services Coordinator, Advanced will report to the Senior Manager, FCR. In this role you will assist the Utilization Management Nurses and Operations Specialist to ensure a timely review of facility compliance claims, including monitoring queues, assisting with administrative support to the FCR team. Your Work In this role, you will: Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemail Handle customer/provider problematic calls Check member history for case management triage and research member eligibility/benefits and provider networks Assign initial EOA days, or triage to nurses, based on established workflow Assists with system letters, requests for information and data entry. Monitors for Medical Records Outstanding (MRO), keeps track to ensure timely receipt and filing of medical records. Requires occasional visits to the office to collect these medical records. Provides administrative/clerical support to the FCR team. Acts as a liaison, gather information and track all patients referred to the care management programs Work with the Operations Specialist and Senior Manager on projects as assigned. Monitor specific queues/workstreams and generates pre-defined reports to identify and resolve common errors. Your Knowledge and Experience Requires a high school diploma or equivalent Requires at least 5 years of prior relevant experience Requires health insurance/managed care experience Requires strong computer navigation skills Requires independent motivation and strong work ethic Our Values Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals PDN-97425b1f-4c4d-49bb-8b81-0c5332b74be4

Keywords: Blue Shield of California, Rancho Cordova , Clinical Services Coordinator, Advanced, Healthcare , Rancho Cordova, California

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