Your Role

The Medical Care Solutions Federal Employee Program team provides Prior Authorization and Utilization Management services to our members. The Clinical Support Coordinator will report to the Non-Clinical Operations Manager. In this role you will be responsible for a combination of answering a high-volume of inquiry calls, receiving and processing admits from hospitals when members are admitted to a facility, receiving and loading Prior Authorization requests into in-house computer software, and other duties as assigned.

Your Work

In this role, you will:

• Answer a high volume of phone inquiries and load faxed authorizations
• Data entry including prior authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSCs
• Assign initial EOA days, or triage to nurses, based on established workflow
• Select support for Case Manager such as mailings, surveys
• Research member eligibility/benefits and provider networks
• Verify member eligibility
• Process hospital admits
• Send referrals to Case Management as appropriate
• Other duties as assigned

Your Knowledge and Experience

• Requires a high school diploma or equivalent
• Requires at least 3 years of prior relevant experience
• Prefers strong attendance record
• Prefers solid technical skills - ability to navigate MS programs and learn in-house software
• Prefers sharp communication and teamwork skills
• Preferred - experience within FEP using AuthAccel and FEP Direct
• Preferred - experience with medical coding - CPT/Dx

Salary Range

The pay range for this role is: $ 20.47 to $ 28.66 for California.

Note

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.