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Wellmark Blue Cross and Blue Shield · 1 day ago

Health Services Clinical Support Specialist (Remote eligible after training)

United States

Full-time

Remote

Entry Level

1+ years exp

Wellmark, Inc. is a mutual insurance company committed to the well-being of its members through exceptional service and innovation. The Health Services Clinical Support Specialist will provide administrative support to the care management team, making outbound calls and gathering clinical information to assist with medical necessity reviews.

Financial ServicesHealth InsuranceInsurancePersonal Health

No H1B

Responsibilities

Support clinical staff by assisting them with gathering data to complete the medical necessity review process. Complete outbound inquiries via phone/fax to obtain discharge dates, and/or to request clinical information as directed by the Care Coordination Nurses

Create and send letters to providers and/or members to communicate information

Work in collaboration with other care management teams and stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member

Meet both quality assurance and production metrics established by Health Services

Perform accurate, timely documentation of pertinent information as defined in department guidelines

Comply with regulatory standards, accreditation standards and internal guidelines; remain current and consistent with the standards pertinent to Health Services

Provide backup assistance to team members as needed

Other duties as assigned

Qualification

Health insurance knowledgeMedical codingMicrosoft Office proficiencyCommunication skillsTeam collaborationAttention to detailCritical thinkingAdaptabilityActive listeningTime management

Required

High School Diploma or GED

1+ years of related experience in health insurance or health care industry experience with knowledge of health insurance terminology and medical coding, including the ability to translate jargon and abbreviations to medical language

Experience producing medical reports, correspondence, records, patient care information, statistics, medical research and/or administrative material

Strong written and verbal communication skills with the ability to communicate complex concepts clearly and concisely to stakeholders

Proficiency with Microsoft Office applications

Experience working in a team environment

Experience establishing relationships and effectively engaging with members and providers by demonstrating active listening skills through telephonic communication to obtain necessary information

Ability to work in a fast-paced environment where production and/or quality goals are measured

Demonstrated commitment to timeliness, prioritization, accuracy, and attention to detail