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Job Details:
Position Name : Clinical Support Associate- Remote Option
Location: Santa Barbara, CA 93110
Job ID : 837e3d9b9d8113c9
Description : General CSA Duties and Responsibilities: Timely answering of inbound calls in the Health Services’ phone queuesMake outbound calls to providers, members, and CenCal Health staff regarding operational processesTimely communication of conflicts or difficulties with members or providers to the immediate supervisorMaintain confidentiality and privacy of member information in adherence to HIPAA and Confidentiality laws and regulationsAdhere to CenCal Health’s mission, protocols, policies and procedures and meet required performance standardsTimely attendance of Company-wide and department meetings and trainings and, as appropriate, actively participateRespond to emails, telephone calls, and other modes of communication promptly, professionally and courteouslyInteract with CenCal Health employees, members, and providers professionallyThe CSA will be assigned to a core unit (UM, CM, CC, DM, BH or Pediatric).Answer inbound calls from unit phone queue and make outbound calls to providers and members regarding authorization request statusAccurately enter authorization requests and submitted documents into the authorization systemObtain all necessary documentation required to process referrals and requests for covered servicesRespond to inquiries regarding the authorization processes and request statuses from providers, members and staff from other departmentsAct as a liaison between clinical reviewers and providers/membersAccurately enter billing and diagnosis codes, category and type of service, amount, frequency, and/or volume of requested or approved services and proceduresProcess authorization requests within established timeliness standardsTrack and monitor timeliness of service authorization and referral requestsAccurately prepare, edit and finalize written determination notices to providers and membersPrepare timely and accurately formatted notices and retain/store documents related to authorization request and determination noticesVerify eligibility and/or other payor sourceCollaborate and communicate with other Health Plan departments such as, but not limited to, Member Services, Providers Services and ClaimsInform members and providers of the authorization and appeal processesAdhere to authorization timelines of Federal and State agencies that govern health plan operationsAs directed, process long term care recertificationAs directed, process inpatient authorization requestProcess limited authorization request according to written guidelinesWork closely with the clinical team, which includes physicians, nurses, and social workersAs assigned, telephonically screen the member’s well-being and/or make contact to their family or authorized representativeAs assigned by the clinician, perform tasks identified in a member-centered care plan to meet or progress toward established goals or outcomesAs assigned, follow members who are in the lowest level of case management or care coordination servicesPromptly communicate any changes in a member status to the assigned clinicianOrganize, schedule, track and monitor member contactsSubmit accurate reports and complete documentation in a timely mannerPerform timely outreach calls to membersAssist members with completing health surveysGenerate and mail post-program satisfaction survey; and as necessary, perform outreach callsAdhere to department protocols and procedures for electronic data entry and form completionAs requested, participate in the case conference and care plan developmentProvide members with community and referral resources that may benefit their ability to self-manage their condition and/or maintain their independenceWork collaboratively with the clinical team to monitor the member’s adherence to their established care planAct as an advocate for the member, recognizing the member’s individual valuesExperienceRequiredAssociate’s degree in business, health science, healthcare, health management or related field OR three (3) years of experience as a Certified Medical Assistant, Certified Nursing Assistant or Licensed Vocational/Practical Nurse may substitute for an Associate DegreeJob Type: Full-time
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