Clinical Services Coordinator, Intermediate

at  Blue Shield of California

YOUR WORK

In this role, you will:

• Assist with member notifications sent out to providers and Members
• Ensure all notifications are completed within turn-around times to meet compliance
• Run, sort and filter daily internal reports for manual outreach
• Make outbound calls to BSC members and providers related to decisioned prior authorization request
• Data entry related to authorization request, high risk member information, HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSC
• Research member eligibility/benefits and provider networks

QUALIFICATIONSYOUR KNOWLEDGE AND EXPERIENCE

• High School diploma or equivalent required
• Typically, requires minimum of 3 years of experience. May require vocational or technical education in addition to prior work experience.
• Requires basic job knowledge of systems and procedures obtained through prior work
• experience or education.
• Prior customer service background strongly preferred
• Intermediate proficiency in Microsoft Outlook; written, organizational, and verbal communication skills
• Flexible, open-minded, and able to adapt positively to business changes or needs
• Great customer service skills

PHYSICAL REQUIREMENTS:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

JOB DESCRIPTIONYOUR ROLE

The Clinical Services Coordinator team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Clinical Services Coordinator, Intermediate, will report to the Operations Supervisor. In this role you will assist with data entry, outbound calls, run reports and manage authorization queues.

In this role, you will:

• Assist with member notifications sent out to providers and Members
• Ensure all notifications are completed within turn-around times to meet compliance
• Run, sort and filter daily internal reports for manual outreach
• Make outbound calls to BSC members and providers related to decisioned prior authorization request
• Data entry related to authorization request, high risk member information, HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSC
• Research member eligibility/benefits and provider network