Clinical Intake Correspondence Specialist – R-5301_2-4185

This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2268572 Clinical Intake
Correspondence Specialist

Work from home within WA, ID, OR, and UT

Hours for this role may include Wednesday – Sunday or
Thursday – Monday shifts. Weekend work is required based on assigned
shift.

Build a career with purpose. Join our

Cause

to create a person-focused and economically sustainable health care
system.

Who We Are Looking For:

Every day, Cambias dedicated team of Correspondence Specialist are
living our mission to make health care easier and lives better. As a
member of the Correspondence Specialist team receive, research, and take
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.

What You Bring to Cambia:

Qualifications:

– high school diploma or GED
– 3 years Regence Customer Service experience or 3 years Clinical
Services experience or equivalent combination or education and
experience.

Skills and Attributes:

– 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.

What You Will Do At Cambia:

– 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.

Work Environment:

– Shifts vary Sun-Sat, 6 AM – 8 PM. Occasional Overtime, and potential
to work rotating Holidays

Why Cambia?

When you work at Cambia, you become part of a purpose-driven,
award-winning culture built on trust and innovation. Our caring and
supportive colleagues are some of the best and brightest in the
industry, innovating together toward sustainable, person-focused health
care. Whether were helping members, lending a hand to a colleague or
volunteering in our communities, our compassion, empathy, and team
spirit always shine through.

We believe a career at Cambia is more than just a paycheck – and that
your compensation should be, too. Our compensation package includes c