Clinical Intake Phone Specialist
Cambia Health Solutions

Boise, Idaho

This job has expired.


Clinical Intake Phone Specialist

Remote within WA, ID, OR, and UT

Primary Job Purpose:

Clinical Intake Phone Specialists are the primary telephone contact to provide benefits, eligibility, education, and assistance regarding Utilization Management (UM), Care Management (CM), and Disease Management (DM) programs.

Normally to be proficient in the competencies listed below:

This individual would have a high school diploma or GED and three years of Customer Service experience, or one year of Customer Service experience and two years of Clinical Services experience, or equivalent combination of education and experience.

Responsibilities:

  • Dependable, customer-focused, and adheres to performance criteria including timeliness, production, and quality standards for all work as established by the department.
  • Communicates with subscribers, providers, agents/brokers, attorneys, other member representatives, internal staff, and the general public with inquiries regarding benefits, authorizations, denials, eligibility, and case management for all designated lines of business.
  • Demonstrates accountability, effective listening skills, and strong communication abilities. Works well with both satisfied and dissatisfied callers to resolve issues accurately and efficiently with minimal direction.
  • Quickly and accurately assesses inquiries and requirements by establishing a rapport with the caller to better understand their service needs.
  • Validates pre-authorization requirements, member benefits, and eligibility, then documents information in the appropriate tracking system. Recognizes errors promptly and identifies appropriate resolutions.
  • Provides assistance and education to callers regarding benefits, eligibility, pre-authorizations, medical necessity, contract exclusions and limitations, managed care products, medical review and referrals, and grievance/appeal procedures.
  • Verifies and as appropriate, explains coordination of benefits and dual coverage as it pertains to UM, CM, and DM services.
  • Manages high volume of calls daily, prioritizes follow-through, and documents member inquiries and actions on tracking system and/or by completing logs.
  • Applies knowledge and understanding to research, and responds to both simple and moderately complex inquiries regarding UM, CM, and DM processes and requirements from members, providers, employer groups, agents, member representatives and internal customers.
  • Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality and compliance with federal, state, BCBSA and accreditation regulations.
  • Receives requests for UM, CM, or DM services, and creates cases in the CM system as appropriate. Coordinates with Clinical Staff as needed. May administratively authorize services advised by Clinical Services Management.
  • Uses knowledge and experience to analyze contractual or administrative issues related to the requests. Identifies additional information needed and requests it when appropriate, but does not perform any activities that require evaluation or interpretation of clinical information.
  • Responds to inquiries using scripted language or simple correspondence as applicable. Does not create or draft language for written correspondence.
  • Provides information pertaining to UM and CM processes, as well as DM programs, to Customer and Provider Service call center Specialists and Ambassadors.
  • May assist teammates as needed.
  • Performs detailed research and problem solving to assist both internal and external customers using sound decision-making skills after thoroughly researching the facts.
  • May participate in quality activities, task forces or work groups, or other training and/or process improvement teams.
  • Assumes a leadership role in identifying areas for improving the customer service system(s) and make appropriate recommendations. May assist with systems testing if applicable.
  • Functions as a back up to the Lead if assigned by supervisor.

Minimum Requirements:
  • Intermediate digital literacy (e.g. Microsoft Office, Outlook, Internet search) and experience with health care systems documentation (EMR, billing, claims).
  • Excellent verbal and interpersonal communication skills and courteous telephone etiquette.
  • Strong customer service skills including listening, patience, and compassion, while maintaining confidentiality and focusing on the caller's needs.
  • Strong organization, data entry and administrative skills.
  • Ability to work independently, prioritize work, meet deadlines and achieve operational standards.
  • Basic knowledge of medical terminology, anatomy, and coding, and understanding of clinical services department programs (UM, CM, DM) and operations preferred.
  • Ability to adapt to a fast-paced environment and learn new or evolving information, procedures, and policies, and accurately explain them to callers.
  • Ability to work as part of a team and independently as necessary.

Work Environment:
  • May be required to work overtime

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

Information about how Cambia Heath Solutions collects, uses, and discloses information is available in our Privacy Policy.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.


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