Clinical Support Coordinator
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AI Summary
Provides administrative support to Care Managers by processing authorizations and non-contracted provider referrals. Responsible for researching, analyzing, and entering service requests while ensuring compliance with clinical policies and performance standards.
Site: Mass General Brigham Health Plan Holding Company, Inc.
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.Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
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
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$19.81 - $28.30/Hourly
Grade
3
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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