Clinical Support Coordinator, Care Part. Adm.

Job ID
2020-3019
Category
Clinical (Community)
Type
Regular Full-Time
Actual Work Location
Charlestown, MA

Why This Role is Important to Us

This position includes a variety of clinical support functions for clinical staff, clinical managers and clinical directors who care for CCA’s Senior Care Options (SCO) and One Care (ICO) members across the state. These functions are related to the overall workflows of CCA’s clinical staff, in addition to managing a variety of internal and external communication requests as directed. This role also entails interaction with members, mostly over the phone. The position provides administrative support for both clinical and non-clinical office-based staff as needed.

What You'll Be Doing

The assignments performed by a Clinical Support Coordinator are structured in the main support functions listed below:

 

  • Triaging
    • Triage phone calls from members, vendors, agencies, and staff - including urgent communications
    • Triage documents: scanning, faxing, sorting, and assigning documents to staff, or department work queue to be followed up in the appropriate Electronic Medical Record (such as eClinicalWorks, EPIC, CIS, Athena, etc.) and/or Care Management Platform (Guiding Care) - including urgent communications
    • Triage and distribute tasks to interdepartmental workgroups/staff within the appropriate Electronic Medical Record and/or Care Management Platform per guidelines established by leadership

 

  • Authorizations
    • Provide accurate, prompt, and appropriate entry of medical referrals and requests from CCA clinicians, members, vendors, and/or providers for services needing prior authorizations
    • Ensure submission of information needed for completion of service decision requests based as validated and instructed by clinical staff
    • Provide clear and accurate documentation of all communication and activities
    • Handle all requests timely and accurately, adhering to performance and compliance measures

 

  • Fulfillment
    • Place orders with vendors based on clinical staff and/or member requests for supplies, equipment, and/or services
    • Coordinate procurement of support services in the community authorized by clinical staff
    • Follow-up on order accuracy, timeliness, and delivery/shipment of goods and services, as well as member outreach to confirm the appropriateness of the order and/or service provided
    • Manage exceptions and substitutions. Work to resolve problems
    • Ensure closed loop communication processes

 

  • Data Integrity
    • Update and maintain data in multiple Electronic Medical Records (internal and external), Care Management Platform (Guiding Care), and Enrollment Platform (Market Prominence) with accurate information regarding clinical care team, support service agency assignment, and member demographics
    • Reconcile data displayed in multiple Electronic Medical Records (internal and external) and Care Management Platform to ensure accurate data on reporting for managerial, operational, and financial purposes

 

What We're Looking For

  • Associate degree or at least 2+ years of applicable experience required. Bachelor’s degree preferred.
  • 2+ years office/administration.
  • Experience working in a health plan, medical group, health-related facility or medical/DME supplier a plus.
  • Education, training or experience as an insurance coordinator or medical coder/biller a plus.
  • Excellent critical thinking and troubleshooting skills
  • Strong customer service and problem-solving skills
  • Comfortable working in multiple systems, often simultaneously
  • Clear, concise and efficient communication techniques
  • Self-manageable and a demonstrated ability to work independently
  • Flexibility to adapt to business needs
  • Motivated team player
  • Excellent organizational skills
  • High attention to detail and accuracy
  • Knowledge of medical terminology (preferred)
  • Basic arithmetic skills required
  • Working knowledge of CPT and ICD coding (preferred)
  • Proficiency in Microsoft Office Suite
  • English required, bilingual preferred
  • Standard office equipment
  • Experience with Electronic Medical Records and/ or Care Management Platform preferred

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