Clinical Services Coordinator, Advanced
Company: Blue Shield of California
Location: Carmichael
Posted on: June 24, 2025
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Job Description:
Your Role The Facility Compliance Review (FCR) team reviews post
service prepayment facility claims for contract compliance,
industry billing standards, medical necessity and hospital acquired
conditions The Clinical Services Coordinator, Advanced will report
to the Manager, Operations FCR. In this role you will assist the
clinical team to ensure a timely review of facility compliance
claims, including monitoring queues, assisting with administrative
support to the FCR team This will include management of daily
inventory, assisting with researching claims, pulling medical
records and answering questions sent to the FCR mailbox. The main
goal of this team is to support the clinical team to ensure they
have what they need in order to complete the medical necessity
reviews. Your Work In this role, you will: Process faxed/phoned in
authorizations, UM/CM requests, special processing/case types
and/or calls left on voicemail Monitor specific queues/workstreams
and generates pre-defined reports to identify and resolve common
errors Handle customer/provider problematic calls Check member
history for case management triage and research member
eligibility/benefits and provider networks Assign initial EOA days,
or triage to nurses, based on established workflow Assists with
system letters, requests for information and data entry. Monitors
for Medical Records Outstanding (MRO), keeps track to ensure timely
receipt and filing of medical records. Requires occasional visits
to the office to collect these medical records. Provides
administrative/clerical support to the FCR team. Acts as a liaison,
gather information and track all patients referred to the care
management programs Work with the Operations Specialist and Senior
Manager on projects as assigned. Monitor specific
queues/workstreams and generates pre-defined reports to identify
and resolve common errors. Your Knowledge and Experience Requires a
high school diploma or equivalent Requires at least 5 years of
prior relevant experience Requires health insurance/managed care
experience Requires strong computer navigation skills Requires
independent motivation and strong work ethic
Keywords: Blue Shield of California, Carmichael , Clinical Services Coordinator, Advanced, Administration, Clerical , Carmichael, California
