Job Details

🌟Now Hiring: Clinical Intake & Correspondence Specialist I

📍Remote Opportunity- Candidates must reside inOregon, Washington, Idaho, or Utah

🕒Flexible Schedule | Full-Time | Weekends & Evenings May Be Required

Rate: $21/hr-$27/hr

Primary Job Purpose:

The Clinical Intake & Correspondence Specialist I receives, researches, and takes 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.

Minimum Requirements:

-Effective communication and writing skills.

-Excellent interpersonal communication 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 work quickly in a production environment.

-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.

-Ability to be flexible and pivot quickly to handle different tasks as needed.

-Ability to "think outside the box" to determine solutions to problems.

Candidate Nice-to-Have's:

1. Demonstrated knowledge of medical terminology, anatomy, and coding

2. Previous professional experience in health insurance or provider's office (scheduling, front office, etc)

3. Professional/business letter writing and/or correspondence experience.

Normally to be proficient in the competencies listed above:

The Clinical Intake & Correspondence Specialist I would have a high school diploma or GED and 3+ years of Customer Service experience or 3+ years Clinical Services experience or equivalent combination or education and experience.

General Functions and Outcomes:

-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 member's or provider's understanding of the preauthorization process and of the information necessary to effectively process a preauthorization, as needed.

Work Environment:

-Location: Remote - Candidates MUST be located in one of the four states: Oregon, Washington, Idaho or Utah.

-Ability to work weekends/holidays/past 6:00 PM Pacific Time

-Ability to work overtime when needed.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-###-####.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.