CareFirst Careers

Clinical Operations Coordinator

Resp & Qualifications

PURPOSE

Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care. This role supports the Maryland Medicaid and Maryland Medicare Advantage Dual Special Needs Population members. 

Essential Functions

Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.

Reviews authorization requests for initial determination and/or triages for clinical review and resolution.

Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.

Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

 

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level:

High School Diploma

 

Experience:

3 years experience in health care claims/service areas or office support.

 

Knowledge, Skills and Abilities (KSAs)

Ability to effectively participate in a multi-disciplinary team including internal and external participants – Proficient

Excellent communication, organizational and customer service skills – Proficient

Knowledge of basic medical terminology and concepts used in managed care – Proficient

Knowledge of standardized processes and procedures for evaluating medical support operations business practices – Proficient

Excellent independent judgment and decision-making skills, consistently demonstrating tact and diplomacy – Proficient

Ability to pay attention to the minute details of a project or task – Proficient

Experienced in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point – Proficient

Preferred Qualifications

Two years’ experience in health care/managed care setting or previous work experience within division

Knowledge of CPT and ICD-10 coding.

 

 

 

Department

Department: MD Meedicaid- Health Services

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 5/27/21

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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