Clinical In-take Specialist

• The Clinical Intake Specialist (Customer Service) is an integral part of Utilization Management, processing telephonic and fax notifications, referrals, and requests for authorization from members, facilities, and physician offices. The Clinical Intake Specialist (Customer Service) utilizes organizational and communication skills, principals of managed care, knowledge of regulatory requirements, and collaborative interactions with the clinical reviewers and provider community to facilitate efficient and timely requests.
  
  The Clinical Intake Specialist (Customer Service) focuses on building and updating referrals and authorization requests in the member record that are essential to conducting the review process and enabling accurate and timely claims payment. The Clinical Intake Specialist (Customer Service) works primarily by fax and telephone to ensure that all necessary information is received so that an optimal review can be conducted by a team clinician. The Clinical Intake Specialist (Customer Service) demonstrates an understanding of regulatory requirements, principals of managed care and department business goals and objectives.

  WHAT YOU WILL DO:

• • Verify member eligibility, collect demographic and pertinent clinical information, and document results in the computer system

  • Build cases in the computerized member record using information gathered from faxes and/or phone calls

  • Document of information using department standards of documentation

  • Communicate with providers regarding the assigned DRG, and/or any necessary decision data

  • Assign accurate codes to all diagnoses and procedures and the DRG, recoding, and updating cases when applicable

  • Communicate with the Clinical Review team to ensure continuity of the notification, coding, and review processes

  • Manage of workload within regulatory turnaround time requirements and mandated timeframes for processing cases

  • Handle protected health information consistent with department and company policies and regulatory requirements

  • Assist in refinement and implementation of unit workflows to enhance efficiency and support unit/department goals

  • Assist implementation of all new utilization management processes and programs in accordance with business plans to provide quality customer service to all customers;

  • Engage in cross-training to develop the variable skills necessary to support all team responsibilities

  • Other duties as assigned

  WHAT YOU WILL BRING:

  • HS Diploma/GED, required; Associate's degree, preferred

  • Excellent attendance, punctuality & professionalism

  • Must be comfortable working in a high volume & fast paced call center environment

  • Must be able to answer calls/faxes, inquiries & requests with a sense of urgency

  • Superb attention to details & be able to meet deadlines

  • Customer service training or previous Call Center experience, highly desired

  • Knowledge in DRG assignment, Human Anatomy/Physiology/Clinical Disease Processes or Medical Terminology is strongly preferred

  • Strong communication, telephone & writing skills

  • Previous experience in a medical/clinical setting, preferred

  • Proficiency in Microsoft Office/computer programs; Must be Tech Savvy!

  WHAT YOU WILL GET:

  • 100% eligibility on BCBSMA's Benefit & Wellness Plans

  • Required 90-Day Training Program; Must be available to start on Monday December 17, 2018

  • Daytime Work Hours: Monday-Friday 8:30AM-4:32PM

  • Free parking on our Quincy campus!

  • Full support and engagement from a dedicated & dynamic team of leaders & peers

  • Professional development & career opportunities at BCBSMA after 12 months of service

  • Be a part of an organization that celebrates and engages in diversity and inclusiveness

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.