[Remote] Health Services Clinical Support Specialist (Remote eligible after training)

Note: The job is a remote job and is open to candidates in USA. Wellmark Blue Cross and Blue Shield is a mutual insurance company focused on the well-being of its members. The Health Services Clinical Support Specialist will provide support to the care management team by making outbound calls to gather clinical information and assist in the medical necessity review process. Responsibilities • Support clinical staff by assisting them with gathering data to complete the medical necessity review process. Complete outbound inquiries via phone/fax to obtain discharge dates, and/or to request clinical information as directed by the Care Coordination Nurses • Create and send letters to providers and/or members to communicate information • Work in collaboration with other care management teams and stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member • Meet both quality assurance and production metrics established by Health Services • Perform accurate, timely documentation of pertinent information as defined in department guidelines • Comply with regulatory standards, accreditation standards and internal guidelines; remain current and consistent with the standards pertinent to Health Services • Provide backup assistance to team members as needed • Other duties as assigned Skills • High School Diploma or GED • 1+ years of related experience in health insurance or health care industry experience with knowledge of health insurance terminology and medical coding, including the ability to translate jargon and abbreviations to medical language • Experience producing medical reports, correspondence, records, patient care information, statistics, medical research and/or administrative material • Strong written and verbal communication skills with the ability to communicate complex concepts clearly and concisely to stakeholders • Proficiency with Microsoft Office applications • Experience working in a team environment • Experience establishing relationships and effectively engaging with members and providers by demonstrating active listening skills through telephonic communication to obtain necessary information • Ability to work in a fast-paced environment where production and/or quality goals are measured • Demonstrated commitment to timeliness, prioritization, accuracy, and attention to detail • Prior remote work experience in a fast-paced environment Company Overview • Wellmark Blue Cross and Blue Shield and its subsidiaries provide health coverage to more than 2 million members in Iowa and South Dakota. It was founded in 1939, and is headquartered in Des Moines, Iowa, USA, with a workforce of 1001-5000 employees. Its website is http://www.wellmark.com. Apply tot his job Apply To this Job