CLINICAL SERVICES ASSISTANT in Providence, RI at Beacon Health Options

Date Posted: 3/28/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Clinical Service Assistant to join our team at our office in RI.  The Clinical Service Assistant Assist with Department operations. Conduct referrals, after-care  follow-up protocols, investigation of complex member/provider issues not requiring a medical necessity determination, claims issues and managing data to ensure patient and provider continuity of services.  Provide guidance and handle complicated inquiries related to case initiation to internal and external customers.  Educate providers/subscribers in case management processes and help to reconcile inconsistencies and procedural difficulties.    Answer inquiries and resolve problems for Member Services and Clinical Department.  Research actions/inquiries.  Provide support to Clinical Care Managers and Member Services and Clinical Management.  Initiate cases by taking data over the phone from members, providers and contracted companies.  Help to resolve issues and complaints from providers/subscribers needing care management services related to: referrals for treatment, authorizations for services and access to clinical case management.  Answer provider and member inquiries, resolve provider and member problems, and assist case managers with projects as assigned.  Provide orientation and training for new staff.  Interface with other departments to identify resource people to assist with customer service inquiries.  Special projects and other duties including completion of surveys for depression management and mind body health solutions, with transfer to a license clinician for medical necessity determination and/or emergency assessment based on survey scoring.   All duties as assigned related to providing clinical support. 

Position Responsibilities:

Customer Service 

Interface with medical carriers, claims payers, other.  Initiates and maintains positive and productive relationships with external and internal customers. Handles difficult customer service problems and expedites resolution.  Interface with Member Services, Provider Relations, Claims and Clinical Departments.  Maintains positive and productive relationships with external and internal customers.  Assist dept/unit with call management.  Interface with external and internal customers to ensure optimal efficiency of services.  Provide education to providers and members on all aspects of care management services. 

Clinical Support

Verify eligibility against contract requirements prior to case initiation.  Refer benefit questions to the Client. Refer complicated inquires to Care Managers.  Prepare account specific cases for Care Manager follow up. Assist with triage assessment and referral process.  Perform follow-up services for cases which may include , ambulatory follow-up procedures, depression management, medical/behavioral coordination and intensive care management protocols.    Assist Care Managers in gathering data and making appropriate referrals to providers.  Search for specialty providers or referrals in areas with difficult access and may respond to complicated inquiries. May participate in the investigation and resolution of claims and/or case issues.     Collect and transfer non-clinical data.  Acquire structured clinical data.  Perform activities that do not require evaluation or interpretation of clinical data. Obtain and enter discharge information. Participate in periodic systems testing.  

Quality Assurance 

Assist with compliance of regulatory standards.   

Reporting and Data Management

Initiate and maintain all databases and records used by the Department.  Enter data, update and/or correct information, run queries and reports

Administrative Support

Perform administrative and clerical duties as needed, to support the business and service needs of the Department.  Create and generate documents, reports, tables and graphs from raw data. Enter and update information, run reports and interpret data from the system as necessary

Professional Standards

Apply Beacon Health Options policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards.  Meet Departmental expectations, accuracy, productivity and performance standards. Support Beacon Health Options in achieving Mission Statement.  Adhere to the components of the Compliance Program.  Ensure that job tasks are performed in a legal and ethical manner.  Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline.  Adhere to compliance training requirements and understand that training is required condition of employment.   Complete tasks accurately and within required timeframes.

Other Duties as Assigned

Position Requirements:

Education: Prefers a Bachelor’s degree in a Behavioral Health field (Social Work, Psychology, Counseling, Sociology or Nursing).  

Relevant Work Experience:  Minimum of two years experience supporting clinical staff in a Community Mental Health setting or 5 years in a Behavioral Health clinical service support environment. 

Knowledge, Skills & Abilities:

  • Must have experience using management information systems, word processing, and spreadsheet applications including knowledge of Knowledge of program and project management artifacts and their application. Microsoft office.Excellent time management, organizational skills and telephone service skills required.Must demonstrate ability to maintain a professional demeanor during crisis situations. Must possess an excellent work ethic, team attitude and be able to function in a multi-disciplinary team environment.Communication and MIS skills will be demonstrated during the interview process

TO APPLY

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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled