Job Details
Job Location
Main Office - Santa Barbara, CA
Position Type
Full Time
Travel Percentage
None
Job Category
Medical Management
Description
Salary Range: $22.56 - $31.58 per hour
Job Summary
A Clinical Support Associate Enhanced Care Management (CSA-ECM) is assigned to Enhanced Care Management Unit of Medical Management. The CSA-ECM reports to the ECM Program Manager. The CSA-ECM is responsible for providing coordination support for the clinical teams, supporting the daily operational functions, facilitating timely work processes, and performing clerical activities of the ECM unit. The CSA-ECM must have strong and clear written and verbal communication skills. The CSA-ECM is responsible for accurate and timely data entry and data collection. The CSA-ECM interacts with other CenCal Health employees, providers, and members. The CSA-ECM is responsible for processing authorization and referral requests.
Duties & Responsibilities

• Timely answering of inbound calls in the Health Services' phone queues
• Make outbound calls to providers, members, and CenCal Health staff regarding operational processes
• Timely communication of conflicts or difficulties with members or providers to the immediate supervisor
• Maintain confidentiality and privacy of member information in adherence to HIPAA and Confidentiality laws and regulations
• Adhere to CenCal Health's mission, protocols, policies and procedures and meet required performance standards
• Timely attendance of Company-wide and department meetings and trainings and, as appropriate, actively participate
• Respond to emails, telephone calls, and other modes of communication promptly, professionally and courteously
• Interact with CenCal Health employees, members, and providers professionally
• Responsible for supporting the daily operational functions, facilitating timely work processes, and performing clerical activities associated with ECM/CS
• Work closely with CM, ECM/CS team and internal CenCal Departments related to ECM/CS activities
• Managing the call queue; to include providing support to members, ECM/CS providers and internal departments, related to ECM/CS referrals and provider reassignment process.
• Responsible for the ECM/CS referral intake process and ECM provider assignment.
• Conduct follow up calls to members and providers to ensure timely access to ECM/CS services
• Organize, schedule, track and monitor member contacts
• Assist with mailings associated with ECM/CS (Member assignment and Auth approval notifications)
• Accurately enter authorization requests and submitted documents into the authorization system
• Act as a liaison between clinical reviewers and providers/members
• Accurately enter billing and diagnosis codes, category and type of service, amount, frequency, and/or volume of requested or approved services and procedures
• Process authorization requests within established timeliness standards
• Accurately prepare, edit and finalize written determination notices to providers and members
• Assist with mailings of ECM/CS NOA's as requested
• Assist the ECM/CS Program Manager with data tracking as requested
• Other duties as assigned

Qualifications
Knowledge/Skills/Abilities
Required:

• Ability to work independently and follow directions with minimal supervision and as an active participant of an interdisciplinary team
• Ability to utilize constructive feedback as a learning and growth opportunity
• Demonstrate excellent organizational and multi-tasking skills
• Understand basic medical terminology, billing (CPT) and diagnoses (ICD-10) coding
• Maintain member confidentiality and HIPAA compliance
• Must be detail-oriented and maintain clear and accurate records
• Complete assigned duties while adhering to regulatory timelines
• Must be able to type at a minimum of 35 wpm
• Work effectively with people with varying backgrounds and educational levels
• Prepare grammatically correct, clear and concise correspondence

Preferred:

• Basic knowledge of Medi-Cal and its covered services
• Knowledge of health-related community-based organizations, health care delivery systems, and resources for the low income and elderly population
• As designated, bilingual in Spanish (not required for Utilization Management positions)

Education & Experience
Required:

• High school diploma or GED
• Twelve (12) months of full-time, or its equivalent, experience in a medical office, health plan, managed care organization, hospital (ED or inpatient), skilled nursing facility, clinic or other healthcare setting working directly with patients, members, providers and/or other clinicians.
  • Successful completion of one of the following accredited education programs: Medical Assistant or Medical Office Professional. Successful completion can substitute for six (6) months of work experience

Preferred:

• Associate degree in business, health science, healthcare, health management or related field OR three (3) years of experience as a Certified Medical Assistant, Certified Nursing Assistant or Licensed Vocational/Practical Nurse may substitute for an associate degree
• Bachelor's degree in one of the above fields
• Two (2) years of full-time, or its equivalent, of clinical experience in an outpatient or ED clinic, health plan, managed care or medical office setting