Clinical Support Coordinator 1

Day to Day Responsibilities

• Request medical records and/or response requests from providers fax, secure email, or remote electronic medical record system.
• Validate provider contact information and update department repository accurately.
• Follow up on medical records and/or response requests via phone or email and implement appropriate action.
• Manage incoming medical records/responses accurately and timely.
• Review medical records upon receipt for content prior to sending for clinical review.
• Follow up with provider if records are incomplete.
• Consult with CQR Lead/RN as needed on requests and request status.
• Prioritize tasks and assignments to meet turnaround time goals.
• Research provider and member information using internal applications (claims, PCP information, plan type).
• Be an active team member and promote a positive work environment.
• Provide input for continuous process improvement.
• Enter accurate data into department database to ensure accurate reporting.
• Work under limited to moderate supervision on routine tasks.
• Deliver on day-to-day objectives which impact the overall of department goals.

Required Skills (top 3 non-negotiables):

• Detail oriented with strong verbal and written communication skills.
• Agile
• Strong organization and professional letter writing/formatting skills

Preferred Skills (nice to have)

• Health plan and/or medical office experience/basic knowledge of managed care principles (HMO, PPO, Medicare)
• Medical terminology knowledge
• Previous experience working with grievances/quality of care concerns

Education Requirements:

• Education: High school diploma or GED.

Software Skills Required:

• Microsoft Office, includes maintaining Excel spreadsheets.
• Adobe Acrobat.
• Professional letter formatting.
• Right Fax.