Clinical Support Specialist

🔥 11 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $18 - $34 / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💝 Customer Support

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

Healthcare Insurance • Finance • B2C

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 assigned clinical team, as directed by the Team Lead and/or Manager • Assist with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes (e.g. UM, CM) • Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes (e.g. verbal notification, engagement status, discharge plan) • Supports administrative functions with community events (e.g. health fairs) • Accurately documents all interventions in the member’s medical management record in accordance with established policies and procedures • Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership • Adheres to all regulatory and compliance standards, including adherence to all Capital and department specific policies and procedures • Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members to support collaborative medical management functions • Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes • Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training • Identifies opportunities and proposes alternatives for improving the 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 • Strong organizational and time management skills • Demonstrated 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, including 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)

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Comprehensive benefits packaging