Clinical Support Coordinator

Mass General Brigham Health Plan Clinical Support Coordinator

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

The Clinical Support Coordinator is responsible for providing administrative support to the Care Managers (CM) and processing authorizations and non-contracted provider referrals, notifications in accordance with established contractual, benefit, and clinical policies and guidelines within Epic, QNXT, and the provider portal. The primary accountabilities of the position include the research, analysis, adjudication, and data entry of service requests and notices received by fax, telephone, mail, email, or electronically. The incumbent is also responsible for ensuring that service requests, notices, and acknowledgements are processed in a timely, accurate manner in compliance with performance standards regarding telephone service levels and authorization/referral turnaround time and quality. Additionally, the incumbent will assist in various care management and member outreach initiatives and serve a primary role in the research of demographic information, conducting of surveys, the generation of reports, and other projects and duties as assigned.

Essential Functions

• Provide support to UM Care Managers to ensure provider and member customer satisfaction.
• Respond in a timely and accurate manner to internal and external customer inquiries regarding Mass General Brigham Health Plan and Clinical administrative policies and procedures.
• Strong knowledge and understanding of processing requests per Medicare, Medicaid, and commercial lines of business.
• Process outpatient and inpatient authorizations/referrals using appropriate criteria for approval.
• Achieve and maintain compliance with telephone accessibility and authorization/referral performance standards.
• Process online and faxed authorization requests using desktop procedures.
• Upload clinical information to the appropriate authorization in Mass General Brigham Health Plan's online provider portal.
• Enter and/or update clinical information as directed by Care Managers.
• Lead and/or collaborate with other Mass General Brigham Health Plan departments in efforts to achieve success in member care/case management.
• Provide support for various care management and member outreach initiatives.
• Provide alternate coverage during staff absences and position vacancies, as directed.
• Other duties as assigned with or without accommodation.

Qualifications

Education

• High School Diploma or equivalent required

Experience

• At least 2-3 years of administrative assistant or secretarial experience required

Knowledge, Skills, & Abilities

• Proficiency in MS Office.
• Ability to proofread and edit written documents.
• Ability to use the phone system.
• Managing one's own time and the time of others.
• Strong verbal & written communication skills.
• Strong interpersonal, written, and oral skills.
• Ability to use standard office equipment.
• Familiarity with medical terminology.

Additional Job Details (if applicable)

Working Conditions

• This is a remote role that can be done from most US states
• This is a full-time, Monday through Friday role with a 9:00 am to 5:30 pm ET schedule

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$19.81 - $28.30/Hourly

Grade

3