Job title: Clinical Intake Correspondence Specialist I
Company: Cambia Health Solutions
Job description: Clinical Intake Correspondence Specialist I
Remote within WA, ID, OR, and UT
Primary Job Purpose:
The Clinical Intake & Correspondence Specialist I receives, researches, and takes initial action related to documentation and requests from a variety of sources related to Utilization Management (UM) Care Management (CM), and Disease Management (DM) programs. Does not make clinical decisions, but partners with licensed health professionals on appropriate actions and responses.
Normally to be proficient in the competencies listed below:
The Clinical Intake & Correspondence Specialist I would have a high school diploma or GED and 3 years Regence Customer Service experience or 3 years Clinical Services experience or equivalent combination or education and experience.
Responsibilities:
Adheres to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work.
Utilizes knowledge and understanding to research simple to moderately complex documentation and requests related to UM processes and requirements, and CM and DM programs from members, providers, employer groups, agents, member representatives and internal customers.
Reviews requests for completeness of information and identifies additional information needed to initiate the request and asks for it when appropriate, but does not perform any activities that require evaluation or interpretation of clinical information.
Validates preauthorization requirements, member benefits, eligibility, and documents information in the appropriate system. Identifies errors promptly and determines what corrective steps may be taken to resolve errors.
Creates cases for UM, CM, DM in the Care Management System as appropriate. May administratively authorize services as directed by Clinical Services Management.
May coordinate case information in external vendor systems for Medical Director Reviews, as necessary.
Receives medical inpatient admission and discharge notifications, documents admission and discharge notifications as necessary for UM and CM use.
Coordinates reviews with members, providers, clinical staff, other departments, and vendors in order to process the request and provide a complete response, as necessary.
Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality and compliance with federal, state, BCBSA and accreditation regulations. Organizes and keeps readily accessible all reference documents, policies and procedures needed to accomplish this.
Facilitates the members or providers understanding of the preauthorization process and of the information necessary to effectively process a preauthorization, as needed.
Minimum Requirements:
Effective communication and writing skills.
Strong customer service skills including listening, patience, empathy, maintaining confidentiality, and focus on meeting customer needs.
Intermediate computer skills (e.g. Microsoft Office, Outlook, Internet search) and experience with health care systems and documentation (EMR, billing and claims).
Strong organization, data entry, and administrative skills.
Demonstrated knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs). Knowledge and understanding of clinical services department programs (UM, CM, DM) and operations.
Ability to investigate and research issues related to clinical programs and work with clinical staff to resolve.
Ability to work independently, to prioritize work, meet deadlines and achieve operational standards.
Ability to work effectively in a team environment.
Work Environment:
Evening, holiday, and weekend work could be required.
The base pay annual salary range for this job is $18.90 – $34.15/hour, depending on candidate’s geographic location and experience.
The annual incentive payment target for this position is 5%.
Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:
medical, dental, and vision coverage for employees and their eligible family members
annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
paid time off varying by role and tenure in addition to 10 company holidays
up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
one-time furniture and equipment allowance for employees working from home
up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our page.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our site.
Expected salary: $18.9 – 34.15 per hour
Location: Burlington, WA