Clinical Support Specialist

🔥 6 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

• Provides administrative support to the assigned clinical team under the direction of the Team Lead and/or Manager • Performs administrative tasks supporting clinical processes such as utilization management, case management, and population health management • Builds medical management records, including authorizations and referral management • Monitors compliance reports • Completes member and provider communications • Assists with medical record documentation requests • Uses the medical management system to initiate cases and authorizations • Conducts fax, telephone, and written outreach to members and providers • Supports administrative functions at community events such as health fairs • Documents interventions accurately in member medical management records • Supports department compliance and performance through report monitoring and distribution • Adheres to regulatory, compliance, and department policies and procedures • Interacts professionally with internal staff, vendor partners, providers, and members • Identifies and reports potential quality-of-service and quality-of-care issues • Participates in staff meetings, in-services, and corporate training • Identifies opportunities and proposes alternatives to improve Population Management functions

🎯 Requirements

• Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department • High School Diploma required • Continued higher education preferred • Strong organizational and time management skills • Strong attention to detail and accuracy • Ability to follow 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 • Knowledge of regulatory and accreditation standards and requirements, including NCQA and CMS

🏖️ 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