Clinical Services Coordinator, Intermediate

Your Role 

The Medical Care Solutions Federal Employee Program team provides prior authorization and utilization management services to our members. The Clinical Support Coordinator will report to the Operations Management Supervisor. In this role you will be responsible for answering a high-volume of inquiry calls, and advising or requesting from doctor’s offices if prior authorization is required for a given service.  You will also receive and process admits from hospitals when members are admitted to a facility as well as processing prior authorization fax requests.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
 

Your Work 
In this role, you will: 

• Answer a high volume of phone inquiries and load faxed authorizations
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSC
• Assign initial EOA days, or triage to nurses, based on established workflow 
• Research member eligibility/benefits and provider networks 
• Verify member eligibility
• Process hospital admits
• Send referrals to Case Management as appropriate
• Other duties as assigned
   

Your Knowledge and Experience 

• Requires a high school diploma or equivalent
• Requires at least 3 years of prior relevant experience preferably including answering a large volume of inbound calls
• Strong attendance record preferred 
• Solid technical skills – ability to navigate MS programs and learn in-house software
• Sharp communication and teamwork skills
• Preferred – experience within FEP using AuthAccel
• Preferred - experience with medical coding - CPT/Dx

Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.