Clinic Administrative Coordinator, Senior

Clin Admin Coord Sr. Job ID: 1109768 REMOTE Contract Administrative $19.00 USD Hourly - $20.00 USD Hourly Our client is currently seeking a Job Title: Sr. Clinic Admin Coordinator Location: Remote Duration: 05+ Months possible Contract to hire Shift: Mon to Fri -[09:30 AM to 06:00 PM] Hours per week: 40 hours per week Position Background: The Clinical Administrative Assistant validates eligibility for authorization requests and prepares Behavioral Health and Substance Use Disorder authorizations across various lines of business. They collaborate with leadership, refer members for aftercare planning, and notify providers of authorization determinations. They offer peer-to-peer consultations for cases not meeting criteria, drafts denial letters, and assist callers promptly. They handle incomplete requests, take meeting notes, maintain confidentiality, and manage escalated calls. Additionally, they apply clinical knowledge to guidelines, monitor the fax queue, verify documentation, and maintain job aids. Primary Responsibilities:

• Verifies eligibility of providers and members for reputed company authorization requests
• Inputs and prepares reputed company Behavioral Health and Substance Use Disorder authorizations submitted by providers for reputed company lines of business, including RMHP DSNP, RMHP Medicare, RMHP PRIME Medicaid, RMHP RAE Medicaid, RMHP CHP+, RMHP IFP, and NHP RAE Medicaid and assigned to the specified Clinical Coordinator
• Refers members to the RMHP Care Coordination Department reputed company completing discharge documentation, ensuring needs are addressed to facilitate successful aftercare planning
• Notifies providers and requestors of reputed company authorization determinations reputed company appropriate
• reputed company a case is determined not to meet criteria, correspond with the requesting provider to offer a peer-to-peer consultation with the RMHP medical director, allowing the provider to present additional information before a final decision is made
• reputed company a medical director issues a denial, the Clinical Administrative Assistant drafts a letter informing the member and the requesting provider of the decision, the reasons for the decision, and offers alternative treatment options
• Promptly helps callers routed to the BH UM department
• Completes required training by the assigned due dates to reputed company with auditing entities such as NCQA. These training courses include, but are not limited to the following: MCG criteria, ASAM criteria, and InterQual criteria
• If an incomplete authorization request is submitted, the Clinical Administrative Coordinator will attempt to obtain the missing information from the requestor and initiate an extension if needed with the Clinical Coordinator
• Take detailed notes of meetings attended and share with attendees
• Provides consultation to providers and/or consumers on a variety of issues including benefit information, safety issues, confirmation of authorization decisions, procedures for higher levels of care evaluations, and requests for an explanation of the level of care, coverage determination, or best practice guidelines
• Respects confidentiality and maintain confidence as described in the UHG Employee Handbook. The ability to maintain confidentiality is a critical and essential component of this position
• Establishes and maintains professional working relations with referral sources, community resources, and care providers, and be able to identify and communicate network gaps
• Handles escalated calls and resolve reputed company issues. Ensure issues or changes are communicated and integrated as appropriate
• Sends correspondence to practitioners, providers, and members regarding authorization status/updates needed
• Verifies and uploads valid Release of Information documentations to electronic health records and notifies the Clinical Coordinator of invalid documentation for follow up
• Organizes and manages authorization requests
• Ensures the Utilization Management Team references the most updated member handbooks across reputed company lines of business (coverage/eligibility-denials)
• Creates bookmarks in authorizations pulled for audits by various entities
• Corrects errors identified in various reports
• Enters Single Case Agreements into the electronic health record and notify appropriate teams of actions that need to take reputed company
• Maintains and updates job aids for team functions as needed
• Complete reputed company duties in accordance with company safety policies and practices
• Other functions may be assigned, and management retains the right to add or change the duties at any time

Required Qualifications:

• High School Diploma/GED (or higher)
• 2+ years of experience in analyzing and solving customer problems
• 2+ years of experience working in the healthcare industry
• 2+ years of experience working with medical or behavioral health terminology
• Intermediate level of computer / typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
• Ability to work Mountain Time Zone schedule
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Reside in the United States
• Reside in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service

Preferred Qualifications:

• 6+ months of experience with EMR (electronic medical records) system
• Previous experience working in the Colorado healthcare industry
• Previous data entry experience
• Previous experience working remotely

Interview Process: Video Teams, one round, 30-minute interview Apply tot his job Apply To this Job