Clinical Support Coordinator

OVERVIEW:

Our client, a provider of Health, Dental, Vision, Medicaid and Medicare Healthcare service plans in the state of California with 4.7 million members and $22.9 billion of annual revenues, seeks an accomplished Clinical Support Coordinator.

IMPORTANT NOTES:

• This will be a remote job.
• Duration: 3 Months (with potential to extend or convert to FTE)
• Working Hours: 8:00 AM – 4:30 PM PST (40 hours/week)
• Candidate MUST have high-speed wired Internet connection. Wi-Fi / Wireless connections are not allowed.
• Candidate MUST have a reliable home-office environment.

Responsibilities:

• Utilize assigned systems and processes to receive new quality-of-care cases.
• Work with clinical reviewers to prepare letters and request medical records.
• Document all attempts to obtain required information and provide updates to clinical reviewers.
• Monitor incoming emails and faxes for receipt of requested information.
• Ensure cases progress through required process steps within defined timeframes.
• Request medical records and responses from providers via fax, secure email, or remote EMR systems.
• Validate and update provider contact information in departmental repositories.
• Follow up with providers by phone or email regarding outstanding records or responses.
• Review incoming medical records for completeness before forwarding for clinical review.
• Re-contact providers if documentation is incomplete.
• Consult with CQR Lead/RN on complex cases or status concerns.
• Prioritize tasks to meet turnaround time expectations.
• Research provider and member information using internal applications (e.g., claims, PCP details, plan type).
• Enter accurate data into department databases for reporting and tracking purposes.
• Actively contribute to team collaboration and help foster a positive work environment.
• Provide feedback for continuous process improvement initiatives.
• Work with limited to moderate supervision for routine tasks.

Required Qualifications:

• Minimum High School Diploma.
• Candidate must have 3-5 years of prior authorizations background handling medical claims within health insurance industry.
• Strong administrative skills with high attention to detail and time management.
• Ability to work effectively in a fully remote environment.
• Proficiency in Microsoft Word and Excel.
• Experience with Vivaldi or other clinical documentation systems.
• Strong business writing skills.
• Prior experience with health plans, IPAs, or healthcare operations.

I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.

Recruiter Name: Jatin Rattan

Title: Senior Recruiter