Wellmark, Inc. is looking for a Health Services Clinical Support Specialist to join our team. You will provide essential daily support to our care management staff, focusing on communication with clinical providers and managing key administrative processes. This role is eligible for remote work after completing initial training.
What You'll Do
- Make outbound calls to clinical staff regarding denials for services and admissions.
- Schedule peer to peer reviews for Medical Directors.
- Complete prompt and professional outbound phone and fax inquiries to obtain member discharge dates.
- Support and request clinical information as directed by Utilization Management Nurses.
- Provide backup for other Health Services team members as needed.
- Support clinical staff by assisting them with gathering data to complete the medical necessity review process.
- Create and send letters to providers and/or members to communicate information.
- Work in collaboration with other care management teams and stakeholders to provide optimal service.
- 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.
What We're Looking For
- High School Diploma or GED.
- 1+ years of related experience in health insurance or the health care industry with knowledge of health insurance terminology and medical coding.
- 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 through telephonic communication.
- 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.
Nice to Have
- Prior remote work experience in a fast-paced environment.
Technical Stack
- Microsoft Office
Team & Environment
You will work in collaboration with other care management teams and stakeholders. Our culture is motivated by the well-being of members, not profits, and is committed to sustainability, innovation, and putting members first to provide best-in-class service.
Work Mode
This position follows a hybrid work model based in Des Moines, Iowa, and is remote-eligible after training.
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
