Clinical Support Specialist

Summary: Under the direct supervision of the Vice President, Clinical Services and with general responsibility to the Clinical Services Division. The Clinical Support Specialist is responsible for providing essential administrative support to the Clinical Services Division, ensuring efficient patient care operations and seamless coordination across TELUS Health departments and external provider networks. This role supports critical functions including claims processing, benefits verification, and provider network research. The Clinical Support Specialist ensures accurate documentation, maintains positive working relationships with internal departments (Claims, Provider Relations, Customer Success) and external stakeholders (providers, facilities), and contributes to operational efficiency and patient satisfaction through organized, detail-oriented work.

Key Responsibilities:

Claims Review and Processing

1. Review and verify incoming claims for accuracy and completeness using internal systems, cross-referencing both digital records and paper documentation to ensure all required information is present before processing

2. Research and correct returned claims for rate discrepancies or instruction errors; document all findings in the claims management system and identify trends to prevent recurring issues

3. Escalate unresolved or complex claims to assigned Care Coordinators with comprehensive claim history, detailed information, and recommended next steps; maintain ongoing communication to track resolution status

Eligibility and Benefits Verification

4. Confirm patient coverage eligibility, including effective dates and termination dates, by accessing internal eligibility systems and verifying current plan status

5. Verify comprehensive plan coverage details including copays, coinsurance, deductibles, out-of-pocket maximums, and benefit accumulations to ensure accurate cost-sharing information

6. Document all benefit verification inquiries and findings accurately in the patient intake system for comprehensive record-keeping and auditing purposes

7. Communicate verified benefit information to providers in clear, timely, and professional manner to support accurate billing and patient communication

8. Follow up promptly on pending benefit verification requests and provide status updates to maintain provider satisfaction

9. Identify and escalate urgent or complex benefit-related issues to supervisors for immediate attention and resolution

Provider Network Research and Development

10. At the direction of Care Coordinators, research the TELUS Health provider network to identify and compile lists of provider options that align with patient-specific needs, geographic preferences, and treatment requirements

11. Communicate identified network deficiencies and coverage gaps to the Provider Relations department; collaborate with network development specialists to ensure adequate and appropriate network coverage for the membership population

12. Submit patient-specific provider requests initiated through retrospective claims review, patient requests, and documented network deficiencies to support continuous network improvement

13. Maintain organized records of provider research activities and network development initiatives

General Administrative Duties

14. Maintain accurate, organized, and compliant documentation standards for all claims, benefits verifications, and research activities

15. Adhere to all TELUS Health policies, HIPAA regulations, and data security standards

16. Perform other related duties as directed or deemed appropriate by supervisory staff

Qualifications:

· Bachelor's Degree in Psychology or other Mental Health related field

· 1-2 years of professional experience in healthcare, clinical, or insurance administration

· Advanced organizational and time management skills with demonstrated ability to manage complex, multi-faceted priorities independently

· Excellent written and verbal communication skills

· Proficiency with Microsoft Office Suite and healthcare-related software systems

· Demonstrated attention to detail and accuracy in data entry, analysis, and documentation

· Professional demeanor and strong interpersonal skills

· Commitment to maintaining strict patient confidentiality and HIPAA compliance

Join our team as a Clinical Support Specialist to play a crucial role in delivering exceptional healthcare support services that improve patient outcomes while fostering an organized, efficient clinical environment!

Pay: $56,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Education:

• Bachelor's (Preferred)

Work Location: In person

Salary : $56,000 - $60,000