Clinical Support Specialist

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $19 - $35 / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💝 Customer Support

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Provide administrative support to the assigned clinical team under the direction of the Team Lead and/or Manager • Perform administrative tasks supporting clinical processes such as utilization management, case management, and population health management • Build medical management records, including authorizations and referral management • Monitor compliance reports • Complete member and provider communications • Assist with medical record documentation requests • Use the medical management system to initiate cases and authorizations • Conduct fax, telephone, and written outreach to members and providers regarding utilization and case management processes • Support administrative functions at community events such as health fairs • Document all interventions accurately in members’ medical management records • Monitor and distribute reports and support department compliance and performance • Interact professionally with internal staff, vendor partners, providers, and members • Identify and report potential quality-of-service or quality-of-care issues • Participate in staff meetings, in-services, and corporate training • Identify opportunities and propose alternatives to improve Population Management functions

🎯 Requirements

• High School Diploma required • Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department • Strong organizational and time management skills • Strong attention to detail and accuracy • Ability to follow job responsibilities as outlined in departmental policies and procedures • Excellent written and oral communication skills • Working knowledge and operation of a personal computer • Proficiency in Microsoft Office applications • Working knowledge of medical terminology • Working knowledge of the health insurance industry, health plan benefits and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive) • Knowledge of regulatory and accreditation standards and requirements (e.g. NCQA, CMS) • Adherence to all regulatory and compliance standards and Capital and department-specific policies and procedures

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible work environment • Training and continuing education • Community volunteering opportunities