What are the responsibilities and job description for the Clinical Services Coordinator, Advanced position at Blue Shield of California?
Your Role
The Clinical Services Coordinator for the Blue Shield Promise Clinical Access Programs department is responsible for requesting and retrieving Medi-Cal member medical records from Medi-Cal network providers to ensure that providers are compliant with providing appropriate care to our Medi-Cal members. In this role you will be responsible for requesting, tracking, following up, and escalating requests to obtain medical records for audits. The Clinical Services Coordinator will report to the Manager, Clinical Training & Auditing.
Your Work
In this role, you will:
- Create and maintain databases of medical records requests and track receipt of requested medical records
- Perform medical record retrieval outreach by fax, email and phone to providers and medical groups
- Document dates, times and results of all outreach attempts in Excel spreadsheets
- Assist with system letters regarding requests for information and data entry
- Provide reports on status of all medical records requests for dashboard reporting
- Utilize Electronic Medical Record (EMR) systems to retrieve required medical records
- Successfully manage the timely medical record retrieval for 500 medical records a quarter
- Promptly escalate non-responsive providers/medical groups to Manager per escalation procedure
- Assist with medical record retrieval for regulatory audits
- Develop professional relationships with provider offices for both Los Angeles and San Diego counties
- Participate in Team and Department meetings
- Collaborate with the Nurse Auditors and the Business Analyst regarding quarterly reporting and audits as needed
- Assign medical records to Nurse Auditors, as instructed
- Work collaboratively with Nurse Auditors to request additional necessary medical records, as needed
Your Knowledge and Experience
- A minimum of a high school diploma
- Requires at least 5 years of prior relevant experience working in a physician, medical office, or hospital setting
- Knowledge of healthcare terminology utilized in medical records
- Expertise in Microsoft Office (Word, Excel, Outlook)
- Ability to work independently and accomplish assigned tasks within limited turn-around-time
- Excellent organizational skills
- Excellent written and verbal communication skills
- Health Plan, IPA, Public Health, Quality Improvement experience desired
- Familiarity with EMR systems preferred
Pay Range:
The pay range for this role is: $ 22.69 to $ 31.77 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
About the Company:
Blue Shield of California
