Commonwealth Care Alliance Service Request Intake Specialist in Springfield, Massachusetts
Commonwealth Care Alliance’s (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA’s benefits plan.
The Service Authorization Specialist is responsible for providing accurate, prompt, and appropriate entry of all medical referrals and requests from CCA Clinicians, Members, Vendors and Providers for services needing prior authorization. The Service Authorizations Specialist reports to the Service Authorization Intake Manager.
At Commonwealth Care Alliance (CCA), our vision is to lead the way in transforming the nation’s healthcare for individuals with the most significant needs. If being part of a team and working on combined solutions for patients matters to you…keep reading. We may have something to talk about.
At CCA, your role matters. You’ll be joining an organization that is mission driven, believes in internal mobility, has excellent benefits and embraces innovation when it comes to serving our patients.
Coordinates with the clinical teams to conduct non‐clinical activities required for medical management (e.g, ensuring submissions for completeness and accuracy, data entering required information, submitting service requests for clinical review).
Assists with the accurate collection of necessary structured data for completion of service decision request.
Provides clear and accurate documentation of all communication and activities.
Handles all requests timely and accurately, adhering to performance measures.
Associate's Degree or equivalent experience
Education, training or experience as a medical coder, medical billing, Insurance Coordinator or other relevant clinical background preferred
Medical terminology knowledge necessary
Basic arithmetic skills required.
Working knowledge of CPT and ICD coding
Demonstrated ability of critical thinking skills to efficiently organize work and maintain a high level of accuracy and productivity
Working knowledge and ability to navigate through the healthcare system (insurances, Medicare, Medicaid, physician office operations)
Ability to work independently with minimal supervision; as well as ability to work well in a team model to solve problems, improve workflow, and maintain cooperative working relationships with stakeholders
Proficiency in Microsoft Office Suite
Strong customer service and problem solving skills
English required, bilingual preferred
Job Title for Posting: Service Request Intake Specialist
External Company Name: Commonwealth Care Alliance, Inc.
External Company URL: http://www.commonwealthcarealliance.org/
Actual Work Location: 101 Wason, Springfield, MA