Clinical Administrative Coordinator Resume Samples

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C Von

Claudia

Von

56046 Tyrique Pass

Houston

+1 (555) 376 6956

56046 Tyrique Pass

Houston

Phone

p +1 (555) 376 6956

Experience Experience

Phoenix, AZ

Clinical Administrative Coordinator

Phoenix, AZ

Kemmer and Sons

Phoenix, AZ

Clinical Administrative Coordinator

Establish and maintain effective working relationships with co-workers, supervisors, manager
Provide excellent service and communication to members, providers Care managers and Managers
Establish and maintain effective working relationships with co-workers, supervisors, managers, stakeholders, and the general public
Work with facilities and vendors to manage request for services from members and/or providers
Work with nurses and the clinical team to manage request for services from members and/or providers
Organize work and develop strategies to adapt to constantly changing workload as evidenced by
Make outbound calls to contact Providers, requesting clinical from provider as necessary

Phoenix, AZ

Associate Clinical Administrative Coordinator

Phoenix, AZ

Reynolds-Stroman

Phoenix, AZ

Associate Clinical Administrative Coordinator

Organizing work and develop strategies to adapt to constantly changing workload
Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers
Provide excellent Customer Service to both Providers and Members
Works on simple tasks using established procedures
Provides document support management of any electronic communication in order to meet client service agreements
Facilitates IME Addendums at the direction of the Account or their representative, Case Manager or Management team
Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review

present

Dallas, TX

Senior Clinical Administrative Coordinator

Dallas, TX

Wyman Group

present

Dallas, TX

Senior Clinical Administrative Coordinator

present

Assists with administrative/enrollment activities for special programs e.g. disease management, complex case management, behavioral health referrals
Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
Work with providers and / or the clinical team to manage request for long term and respite services
Work with providers and/or the clinical team to manage request for long term and respite services
Inbound/outbound phone calls to providers other internal departments to assist with notifications, documentation
Work is frequently completed without established procedures
Assist manager/supervisor/HSD

Education Education

Bachelor’s Degree in Healthcare

Loyola University Chicago

Bachelor’s Degree in Healthcare

Skills Skills

Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance
Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
Strong attention to detail
Show great accountability for work
Self-starter who is able to work in fast-paced environment, able to multi-task, and work independently
Good communication skills and ability to work in a team environment
Excellent telephone skills; ability to handle calls in a courteous and helpful manner
Excellent active listening and communication skills
Manage incoming calls, managing requests for services from providers / members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the request process, processes incoming and outgoing information, and prior authorizations
Manage administrative tasks of minor home modification department, monitor and update Sharepoint site, schedule and attend IDT calls and document outcomes on Sharepoint site

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Clinical Administrative Coordinator Resume Examples & Samples

Contact insurance companies to gather benefit information
Re-verify patient eligibility, monitor insurance lifetime caps and prior authorization periods
Demonstrate interpersonal skills among co-workers, internal departments, and referral sources
Participate in Departmental, Clinical and Company meetings as requested
May assist with training of other team members, as needed
Comfortable working Monday-Friday an 8 hour shift between 7:00 am - 7:00 pm with possible OT. During peak season must be able to work weekends (typically the month of January)
Experience using a computer and Microsoft Office (Word, Excel, and Outlook)
Experience working with Healthcare Insurance

Clinical Administrative Coordinator Resume Examples & Samples

Drafting of NOA/NOE letters for government and Commercial Specific clients
Responsible for ensuring the letter documentation meets client, regulatory and accreditation requirements
Knowledge of the State and Federal regulations concerning the services and benefits
Must demonstrate understanding of the program by selecting the correct letter template
Other duties as assigned by manager and/or director
2+ years of professional experience in an office/customer service environment
2+ years of professional experience in Clerical or Administrator work
1+ years of experience with Medical Terminology
Proficiency in Microsoft Word, Excel, and Outlook
Computer proficiency including, but not limited to, ability to learn new computer system applications
Available to work between the hours of 6:00 am - 7:00 pm, flexible schedule Monday through Saturday
Bachelor's Degree (or higher)
2+ years of professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties or 2+ years of Customer Service experience analyzing and solving customer problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD and CPT codes, Medicare and/or Medicaid Services, call center environment
Experience with Outlook
Healthcare or Insurance Benefits experience
Experience in a Medical office billing or Medical Assistant/clerk
Experience with production of NOA/NOE Letters
Knowledge of Medicare, Medicaid, and Commercial programs
Ability to work in a fast-paced, dynamic, rapidly changing environment
Strong aptitude for working in a production driven environment
Must be a self-starter and able to work independently

Clinical Administrative Coordinator Resume Examples & Samples

Respond to incoming provider and enrollee calls
Resolve customer service inquiries which could include: Enter notifications, Providers status of an existing notification and determining if notification is required
Provide excellent customer service to both providers and enrollees
Assist with faxes and emails
Actively participate in departmental quality improvement goals and quality improvement as well as other activities to promote the delivery of the highest quality services to all of the members
1+ year of Customer Service experience in the Healthcare Industry
1+ year of experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties
Experience with Microsoft Office (Word, Excel, and Outlook)
Knowledge of Medical Terminology
Knowledge of Medical Coding (ICD-9 and CPT)
Experience working in a Call Center environment

Clinical Administrative Coordinator Resume Examples & Samples

Access the County of San Diego’s Electronic Health Record (EHR) System to conduct data entry of confidential client/patient information
Serve as a central contact for inpatient, crisis stabilization unit and crisis house bed availability
Process and track inpatient authorization requests within the establish turnaround time
Distribute appropriate clinical work products to clinicians for processing
Manage ongoing updates in Find Resource, the designated database for referrals
Scheduler: generate, disseminate IEX schedules and update internal schedule matrix
Record non-routine disclosures in the designated database
Download and disseminate monthly satisfaction survey results to leadership team
Perform other routine clerical tasks : scan, facsimile, photocopy, file and/or purge documents
Efficiently answer incoming calls and provide courteous service to all customers
Operate a variety of standard office machines and computer software
Effectively respond to verbal requests and written instructions in a timely manner
Establish and maintain effective working relationships with co-workers, supervisors, manager
Assistance to ACL clinicians as needed with overall direction from ACL Afterhours Supervisor
Other duties as assigned by Supervisor/Manager
2+ years of data experience in Administrative or Clerical Support role
Ability to create, edit, save/send documents utilizing Microsoft Word and Excel
Ability to type 50- 60 WPM accurately
Ability to gain and maintain access to the County of San Diego's Electronic Health Record
Ability to work Monday- Wednesday 6:30am-3pm and Thursday 11am-7:30pm
Bachelor's Degree or Some College
Experience working within the Healthcare Industry or Healthcare Insurance
Experience working in a Hospital, Physician's Office,or Medical Clinical setting
Experience handling confidential client/patient information
Must be able to navigate a PC to open multiple applications, send emails, and conduct data entry
Ability to work with multiple screens and applications at one time

Clinical Administrative Coordinator Resume Examples & Samples

2 + years of professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
Experience using Microsoft Word and Outlook
Must be able to work between the hours of 10:00am - 6:30pm, flexible schedule Monday - Friday
Medical Terminology and Coding knowledge
Experience with Microsoft Excel, PowerPoint, Access, Project, Visio, clinical databases, Internet explorer or other web browser
Hospital, physician, or medical clinical experience
Medicare and Medicaid experience
Healthcare or insurance benefits experience
Experience in the Pharmacy field

Clinical Administrative Coordinator Resume Examples & Samples

Ability to type 50- 60 WPM, accurately
Must be able to work Friday - Monday 3:00 pm - 9:30 pm
Bachelor's Degree (or higher) or Some College

Clinical Administrative Coordinator Resume Examples & Samples

Telephonic Outreach to Providers and Members
2+ years of professional experience in a Clerical or Administrative type role
Must be able to create, edit, save and send documents utilizing Microsoft Word, Excel, and Outlook
1+ year of Telephonic Customer Service experience
Associates or Bachelor's Degree
Healthcare Insurance Benefits experience
Experience with the production of NOA/NOE Letters
1+ years of experience working within the Healthcare Industry, Hospital, Physician's Office or Medical Clinical setting
1+ years experience with Medical Terminology

Senior Clinical Administrative Coordinator Resume Examples & Samples

Monitor telephone queues and adjust phone coverage as needed
Create work assignments (phone and non-phone) for regular business hours and as needed, for overtime
Act as a subject matter expert; review job aids and submit intakes for updates or new job aids
Act as a team resource for coaching, special projects and assistance with problem solving
Review and process prior authorization requests to meet departmental key indicator productivity and accuracy standards; maintain minimum of 95% case data entry accuracy
Follow departmental policy regarding accurate documentation of clinical data, demographic and product information, provider/facility contract status, appropriate case routing, and appropriate non-clinical level notifications
Review and process Actions Grams from Issue Resolution Specialists; research problem cases/claims and update Facets accordingly
Maintain 100% accuracy and timeliness of letter generation
Exceed attendance standards set by company policy
3+ years of experience in a healthcare environment (Physician’s office, Hospital or Health Insurance) is required
1+ years experience working with ICD-10 and CPT codes
Ability to type at least 35 wpm
2+ years of telephonic or face-to-face customer service is required
Facets experience
Team Lead experience
Managed Care Organization experience

Clinical Administrative Coordinator Resume Examples & Samples

Pull information from the queue and assign cases to clinical team based on member zip code
Work in spreadsheets and systems to provide member data to the clinical team
Send out clinical information to members
1+ years of experience working in a professional office environment
Experience using multiple systems and programs

Clinical Administrative Coordinator Resume Examples & Samples

Follow departmental policy regarding accurate documentation of clinical data, demographic and product information, provider / facility contract status, appropriate case routing, and appropriate non-clinical level notifications
Process adverse determinations; consistently exceed or meet compliance and business unit requirements (meaningful denial text, timely notification and thorough documentation)
Process UM related pended claims; monitor for trends related to the cause of pended claims; educate co-workers on data-entry errors that cause pended claims; maintain age of UM claims less than 10 days
Review and process Actions Grams from Issue Resolution Specialists; research problem cases / claims and update Facets accordingly
Provide high level of customer service while communicating with internal departments and external provider office staff as pertains to performance of job duties
Take responsibility of problem solving to achieve key indicator goals
Act as a team resource for training, special projects and assistance with problem solving
Maintain productivity standards, including case and call Manage admission notification and case closure
Maintain compliance with turnaround times based on the member’s product, the type of request and the specific regulatory agency
Comfortable working Monday-Friday from 8am-5pm, with OT and weekends possible
2+ years of experience working in the Healthcare field
2+ years of experience working in a Call Center environment
Able to type at least 35 wpm
HCPC Coding experience
Experience with CPT and ICD-10 Coding
Bilingual with English and Spanish

Clinical Administrative Coordinator Resume Examples & Samples

Responsible for Clinical support to the Providers and also the RN staff
You will be faxing, emailing documents, and ordering medical charts
Follow up calls with providers
You will be supporting and working along with a Virtual team
Utilize negotiating skills in resolving issues with various internal departments that impact the "customer" experience
Communicating both verbally and in writing to regulatory agencies as well as other internal departments
* Work from home position but you must reside in Hawaii ***
Comfortable working Monday - Friday 7am-4pm
2+ years of experience working in a Clerical, Administrative Support, or similar role
Experience using a computer and Microsoft Word, Excel and Outlook
Ability to type 40 wpm accurately
Medicare and/or Medicaid experience
Experience in a Hospital, Physician's Office, Medical/Clinical, or with Health Insurance background
Working knowledge of Medical Terminology
Experience with EMR (Electronic Medical Records)

Clinical Administrative Coordinator Resume Examples & Samples

Comfortable working Monday-Friday 8 hour shift from open between 6am-6pm
2 + years of experience in an Office setting environment using the computer as the primary instrument to perform job duties
1 + year of Data Entry experience with proofreading skills
6 + months of experience working in a professional team environment
Experience using a computer and working with Microsoft Word, Excel, and Outlook and utilizing the Internet
Healthcare or Healthcare Insurance experience
Previous experience working in a task-related, repetitive role while maintaining the ability to remain focused and productive each day

Clinical Administrative Coordinator Resume Examples & Samples

Support the enrolled members / beneficiaries of our community partners
Assist manager / supervisor and team with care coordination activities and tasks
Arranging post-discharge appointments, transportation, and transition of our members across the continuum of care
Make appropriate referrals to the Customer Care team to support benefit, billing / payment and eligibility of our members
Outreach calls to our members / beneficiaries post facility discharge
Assist with referrals / calls received by the Care Coordination Unit, and complete community outreach and documentation
Track and interpret data, prepare reports and presentations
Ability to track and interpret data, prepare reports and presentations via Microsoft Office with strong proficiency in Excel
Experience working within the healthcare industry
Working knowledge of medical terminology to communicate with members / beneficiaries and providers
Experience working with Medicare populations
Some college / undergraduate education

Clinical Administrative Coordinator Resume Examples & Samples

Respond to Incoming physician and Members calls
Resolve Customer Service inquiries for Long Term Care (LTC) members which could include
Provide excellent Customer Service to both Providers and Members
Previous experience working in an office setting
Previous experiencing working with Microsoft Outlook, Word and Excel (create correspondence, editing, performing data entry and maintaining spreadsheets)
Experience with Medical Terminology
Healthcare related experience

Clinical Administrative Coordinator Resume Examples & Samples

Responsible for providing customer service and referral interface
Provides support to clinical managers, team managers, and case managers as needed
Fills out missing information and performs data entry on new patient information
Edits and corrects database information as necessary and populates missing information
Performs detailed data entry into client systems per client expectation and service level agreements
Coordinates correspondence and forms for print, mail, faxes, and files as necessary on a daily basis
Generates daily, weekly, monthly reports for account and health plan clients
Prepares materials for packet mailing
Performs monthly eligibility checks on Medicare for case managers on a monthly basis
Responsible for general office/administrative duties including ordering supplies, managing schedules, preparing meeting agendas, recording meeting minutes, and participating in quality audits to ensure all client information is up to date
Performs other duties as assigned by supervisor
Operating hours of Monday - Friday from 9:00 am to 9:00 pm and Saturday from 9:00 am to 6:00 pm. Must be available to work any schedule within our operating hours.Will be off Sundays and one other day during the week
Associate’s Degree (or higher)
Outbound contact center experience
Prior experience in Healthcare industry & HIPAA compliance workplace
Prior experience working in a scripted environment
Ability to use ACD telephone system
Meet or exceed sales/service targets in a performance-based workplace
Ability to use multiple computer applications

Clinical Administrative Coordinator Resume Examples & Samples

2+ years of Customer Service experience analyzing and solving customer's problems
Must be able to create, edit, save/send documents utilizing Microsoft Word and Excel
Must be able to type 50- 60 WPM, accurately
Must be able to gain and maintain access to the County of San Diego's Electronic Health Record
Must be able to work Saturday and Sunday- 6:30am-3:00pm

Clinical Administrative Coordinator Per Diem Resume Examples & Samples

6+ months of experience working in a clerical, administrative support, or similar role
Ability to navigate a PC to open applications, navigate web, send emails, and conduct data entry
Available to work an 8 hour shift Monday through Friday from 8:00 am to 5:00 pm in the even that the FT person is absent
I9 System and/or TrackCS systems knowledge
Ability to understand usage and manage all patient equipment

Associate Clinical Administrative Coordinator Resume Examples & Samples

Print & Fax Letters to provider and members
Stuff Envelopes for member and provider mailing as appropriate
Send letters overnight if applicable
Perform QA to ensure correct member letter with all appropriate pages are inserted in the correct envelope
Demonstrate flexibility, availability, and dependability to conform to position responsibilities
Excellent computer skills with direct experience in Microsoft Office, Word, and Excel required
Make outbound calls
Meet to exceed production standards here
Flexibility to work an 8 hour shift between the hours of 6:00 a.m. and 7:00 p.m. Monday through Saturday
Previous Office experience

Clinical Administrative Coordinator Resume Examples & Samples

Self motivated/Self Starter
Punctual/Consistent Attendance is essential
6+ months of experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties
1+ year alpha/numeric data entry experience
Must be able to create, copy, edit, send & save utilizing (Word, Excel, and Outlook)
Experience in a Clerical or Administrative role
Healthcare or Insurance experience
Medical Terminology/Coding (ICD-10 and CPT) experience
High volume Call Center experience
Hospital, Physician or Medical Clinical experience
Long-Term Care knowledge

Clinical Administrative Coordinator Resume Examples & Samples

Work with facilities and vendors to manage request for services from members and/or providers
Manage the referrals process, with referrals for prior authorization notifications
Receive care coordination notification cases for non-clinical assessment
Handle resolution/inquiries from members and/or providers that may include: Benefit and Eligibility information, Billing and Payment issues, Explanation of Benefits (EOB)
1+ year of experience working in an office setting using a telephone and computer as the primary instruments to perform job duties
Experience working within the Healthcare industry
Bilingual fluency with English and Spanish

Clinical Administrative Coordinator Resume Examples & Samples

Call members and verifying medical services that have been performed
Call providers in order to start services for the members
File all medical paperwork and faxes electronically
Respond to incoming service coordinator calls/emails and resolve inquiries
Mail out documents to the member
Experience navigating a PC and utilizing Microsoft Office (Word, Excel, and Outlook) in a professional setting
Triage experience

Clinical Administrative Coordinator Resume Examples & Samples

Manage phone queue responsibilities for the Pa Special Needs Unit
Respond to member inquiries in real time to their unique questions regarding benefits, locating providers, denials, referring to community resources, etc
Must be able to remain calm in high volume situations and remain flexible in a very changing environment
Ability to present self to callers in a calm, compassionate and knowledgeable manner using active listening skills in order to prevent the member from repeating their story
Work with hospitals, clinics, facilities and the clinical team to manage issues, questions and concerns from members and/or providers
Assist the SNU staff in resolving member issues
Document all member contact in an accurate, timely, concise manner to reflect all activities. Handle resolution/inquiries from members and/or providers that may include
Provider information
Billing and Payment issue
*Work in the Philadelphia office location, no telecommute. Able to multitask, work phone queue and project work for Special Needs Unit

Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative intake of members or the admission/discharge information post notification Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
Prefer a bi-lingual candidate but not mandatory
Have UR experience but not mandatory
Will handle medical only files
Must be able to work 8:00am – 5:00pm
Ability to create, copy, edit, send & save utilizing Word, Excel & Outlook
Able to navigate a PC to open applications, send emails, and conduct data entry
Previous Healthcare Insurance experience
Previous experience with Medical only files
Prior experience working in a Hospital, Physician's Office, or Medical Clinical setting
Professional experience in a Clerical or Administrative support role
ICD-9 and CPT code experience
Prior experience working with Medicare and/or Medicaid Services
Workers Compensation experience

Associate Clinical Administrative Coordinator Resume Examples & Samples

Manage the referrals process, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
Ability to work Monday through Friday from 8:00am - 7:00 pm, flexible schedule
1+ year of Customer Service experience analyzing and solving customer's problems
Experience in the Behavioral Field or with Behavioral Terminology
Bachelor’s Degree, preferably in Behavioral Health or Social Services
Mental Health or Social Services experience is a plus
Any bilingual skills
Need to be comfortable with talking on the phone and possess strong typing skills to perform these functions simultaneously with ease
Ability to maintain confidentiality and adhere to HIPPA requirements
Ability to learn and adapted in a fast-pace environment

Clinical Administrative Coordinator Resume Examples & Samples

2+ years of professional experience in an office / customer service environment
1+ year of experience with Medical Terminology
Must be able to work between the hours of 6:00 am - 7:00 pm, flexible schedule Monday - Saturday

Clinical Administrative Coordinator Resume Examples & Samples

Respond to Incoming Provider and Enrollee calls
Resolve Customer Service inquiries
Provide excellent Customer Service to both Providers and Enrollees
Receives Care Coordination notification cases for non-clinical assessment/intervention and provides appropriate triage
Processes out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products
Processes notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues
Determines benefit coverage issues based on employer group contracts
Sets up/documents/triages cases for (CCR) Clinical Coverage Review
Ensures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
Processes letters within DOL time frames
Verifies appropriate ICD-10 and CPT coding usage
Communicates to providers and members benefit determinations within DOL time frames
1+ years of professional experience in an office/customer service environment
Experience working with Microsoft Word and Excel
Computer experience including, but not limited to, ability to learn new computer system applications
Flexibility to work outside standard hours of operations due to changing business needs
Professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties OR Customer Service experience analyzing and solving customer's problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-9 and CPT codes, Medicare and/or Medicaid Services, Call Center environment
Experience with Outlook or Lotus Notes

Associate Clinical Administrative Coordinator Resume Examples & Samples

Handle resolution/inquiries from members and/or providers that may include: Benefit and Eligibility information, Billing and Payment issues, Customer material requests, Physician assignments, Authorization for treatment, and Verifying appropriate ICD-10 and CPT coding usage
Limited work experience
Works on simple tasks using established procedures
Depends on others for guidance
Work is typically reviewed by others
Previous experience working with Microsoft Word and Excel (must be able to create, edit, save and send documents)
Available to work from 10:00 am to 6:30 pm and weekend overtime as needed
Experience working with ICD-10 and CPT codes
Experience working with Medicare
Working knowledge of Medical Terminology to communicate with Members and Providers

Tricare Clinical Administrative Coordinator Resume Examples & Samples

Process requests for medical records
Mail or fax requests for medical records to facilities and providers within process timelines
Calls facilities and providers for status of requested documents
Document and track status of all medical record requests in medical records database
Files and maintains received medical records and CQM documents per file plan
Processes mail received in the CQM department
Prepare and transfer medical records to the TQMC to meet contract delivery timeline requirements
Processes invoices for received medical records
Maintains and ensures the organization of the medical records room
Archives records when appropriate and per policies and procedures
Assists clinical staff with the assembly of case files
Supervision/guidance is required for higher-level tasks
Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86
Computer skills, including experience with Microsoft Word and Outlook, as well as the ability to navigate a Windows environment
Ability to maintain confidentiality and adhere to HIPAA requirements
Any prior Medical or Healthcare experience in a professional setting
Any experience with EMR (Electronic Medical Records)

Clinical Administrative Coordinator Resume Examples & Samples

Assist with processing faxes and referrals
Enter notifications, provide status updates on existing notifications and determine if notifications are needed
Gather information for state audits
Must have the ability to use multiple computer systems
Must be able to work 10 AM - 7 PM, 8 hour shifts, M - F
2+ years Customer Service experience
2+ years of experience in an office environment using the telephone and computer as the primary instruments to perform the job duties
Proficient knowledge of Microsoft Office and able to navigate a windows environment
1+ year of healthcare experience
Bachelor's Degree in healthcare or a medical-related field
Reside in a West Coast state

Clinical Administrative Coordinator Resume Examples & Samples

Data entry of client information into designated database/Electronic Health Record (EHR) System
Processing and tracking inpatient and outpatient authorization requests, and distribute the appropriate work products to clinical teams for clinical review
Update and validate demographic and diagnosis information in (EHR) as needed
Scanning of documents for retention and filing of documents
Purging of documents
Facsimile and photocopy duties; other assistance to CSS team member as needed with overall direction from CSS Supervisor
Efficiently answer incoming calls and provide prompt and courteous service to customers and guests. External stakeholders include inpatient hospitals; Providers; Billers; CWS; Probation Officers; Attorneys, etc
Position requires ability to access the county’s electronic medical record
Processing Authorizations within the establish TAT, and serving as back up for CSS processes depending on staff availability
Sort through incoming faxes
Cross train in other CSS processes
E-filing of all requests, treatment plans, reports, etc
File data and perform other routine clerical tasks as assigned and for other departments as needed
Operate a variety of standard office machines, including a personal computer and a variety of computer software, DYMO label, phone, fax, calculator, shredding machine and photocopy machine
Interpret and respond clearly and effectively to verbal requests over the phone or in person, and to verbal or written instructions in a timely manner
Establish and maintain effective working relationships with co-workers, supervisors, managers, stakeholders, and the general public
Perform reception duties in an efficient, professional and courteous manner
Pursue personal development of skills and knowledge necessary for the effective performance of the role
Serve as a central contact for crisis stabilization and inpatient bed availability
Implement revised utilization management process for outpatient authorizations
Expand TERM quality review process to include funded cases
Must be able to type 50- 60 WPM
Must be able to gain and maintain access to the County of San Diego's Electronic Health Record, Anasazi
Bachelor's Degree or Some College preferred

Clinical Administrative Coordinator Resume Examples & Samples

Handle pre-authorization calls for upcoming surgeries, hospital admissions, imaging and therapy, etc
Comfortable working Monday - Friday from 10:30 am - 7:00 pm or 11:30 am - 8:00 pm
2+ years of customer service experience analyzing and solving customer issues and concerns
1+ year of experience working in a Call Center
Previous experience working with Microsoft Office (Word, Excel, Outlook) and Windows PC applications, which includes the ability to learn new and complex computer system application and apply their use for phone and off phone
Data Entry Experience
Previous Clinical or Healthcare experience

Clinical Administrative Coordinator Resume Examples & Samples

Associates degree
Experience telecommuting
Bilingual in both English and Spanish
Able to work Central or MT time

Tricare Senior Clinical Administrative Coordinator Resume Examples & Samples

Act as a Subject Matter Expert for other team members
Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
Additional information to be provided by recruitment and the hiring manager
Must be able to work 7 AM - 3 PM or 8 AM to 4 PM Monday through Friday
2+ years of Customer Service experience
Must be able to create, edit, copy, send and save documents, correspondence and spreadsheets in MS Word, Excel, and Outlook
United States Citizenship
Experience working within the Healthcare Industry

Senior Clinical Administrative Coordinator Resume Examples & Samples

Make Outbound calls to reach out to our "Unable-to-Reach" population and attempt to assess/assign a Service Coordinator
Collaborate with Service Coordinators
May coordinate others' activities
1+ years of experience providing telephonic Consulting and Counseling
1+ years of prior Medical/Healthcare experience
Available to work Monday through Friday from 8:00 am to 5:00 pm and overtime as needed
Any Call Center or Member Services experience
Medicaid experience
Experience with ICD-9/ICD-10/CPT coding

Senior Clinical Administrative Coordinator Resume Examples & Samples

Intake/triage of critical incidents
Tracking of work flow of each critical incident via Excel and Access Trackers
Producing communications to members and providers regarding outcomes of investigations
Excellent written, editing and proofreading skills with attention to detail
Ability to multi-task, prioritize and meet strict daily deadlines
Must be an excellent communicator while working with a team comprised of FT telecommuters
Must be able to work independently with minimal supervision
Must be able to work flexible work schedules to include nights, weekends and holidays when needed/required
1+ years of experience working with Medicare, Medicaid or MyCare lines of business
1+ years of experience understanding the sensitivity and knowledge of proper handling and processing of protected health information (PHI)
Proficient/advanced knowledge of computer applications including Microsoft Applications (Excel, Access, Word, Outlook, and PowerPoint)
Ability to frequently check email for critical incidents (either via laptop or smartphone)
Available to travel up to 25% of the time
Available to work an 8 hour shift, Monday through Friday, between 8:00 am and 11:00 pm, open to working later afternoons,evenings, on-call for weekends (soon to be rotating weekends), and on-call for holidays (soon to be rotating holidays)
Must live in Ohio
Associate's Degree or higher
Experience or solid understanding of Home and Community Based Services/Waivers
Experience with Incident Reports
Experience with secure networks, uploading, downloading, and attaching multiple files to documents, Share Point drives, FTP sites, 3rd party vendor applications and government websites

Senior Clinical Administrative Coordinator Resume Examples & Samples

Answer inbound calls in call center and document all calls
Make outbound calls to enroll members into Wellness programs
Collaborate with wellness Coaches and Nurses
Assigns and reassigns members to appropriate Care Coordinator under the direction of the Service Coordination Manager
Monitors member list routinely to assure accurate assignment of all members
Queue Management (EVC/Initial Assessments)
Tracks Nursing Facility and Inpatient census data via the Blended Census Reporting Tool (BCRT)
Communicates member Inpatient status to the assigned Service Coordinator
PCP selection post initial customer service attempts
Assists with administrative/enrollment activities for special programs e.g. disease management, complex case management, behavioral health referrals
Manages incoming communication calls/fax/email/tasking group- members/providers
Assists with outgoing communication (calls/fax/email) follow-up to see that new services started, meeting/not meeting needs distribute service plans/plan of care, other communication to members/providers
Coordinate details of environmental modifications pharmacy issues (customer service)
Completes eligibility related activities- enrollment, disenrollment, tracking Nursing Facility Level Of Care/Waiver eligibility (1148/1147)
Posts member related documents that can't be stored in CareOne to electronic filing system (shared drive/SharePoint)
Documents all member related activities in CareOne
Reminds members of need to complete Medicaid paper work to maintain eligibility
Utilizes plan software to generate care coordination reports
UTL/Refused Contact process
Assist with requesting HCBS services (find provider, verify hours, and submit task to HCBS)
Assist manager/supervisor/HSD
Performs other duties/projects as assigned
Works independently
May coordinate other's activities

Clinical Administrative Coordinator Resume Examples & Samples

Take incoming calls from providers regarding benefit inquiries and resource requests
Collaborate with clinical case managers on administrative tasks for member assessments
Put together reports that are required by the state
Work is frequently conducted with limited established procedures
Manage tasks assigned to you by the case managers
Ability to create, edit, save and send documents utilizing Microsoft Word, Excel, and Outlook
Ability to navigate a PC to open applications, send emails, and conduct Data Entry
Ability keep all information confidential per HIPPA requirements
Working knowledge of basic Medical Terminology to communicate with members and providers

Clinical Administrative Coordinator Resume Examples & Samples

Extract and review fax requests for medical or clinical services
Access electronic member files using policy or id number
Determine member eligibility
Follow protocols to task requests appropriately
Check procedure codes against notification requirements and benefit coverage to determine next steps
Reference automated job aid tools via the computer to identify appropriate procedures when needed
Maintain Confidentiality and adhere to HIPAA Requirements
1+ year of experience in an office setting using the telephone and computer as the
Primary instruments to perform the job duties
Knowledge of Medicare and Medicaid
Ability to create, copy, edit, send and save utilizing Word, Excel and Outlook
Open, sort and distribute incoming correspondence via hard copy or e-mail
Capability to navigate laptop applications, create and send e-mails and formulate data
Entry
30 wpm typing/data entry skills
Advanced Excel skills or Higher
Access Database
Knowledge of operating standard office equipment
Must be able to maintain professionalism and a positive service attitude at all times
Ability to sustain concentration to enter waivers for extended periods of time
Excellent communication skills – written and verbal

Clinical Administrative Coordinator Resume Examples & Samples

Conduct health risk assessments on members via phone
Assist members with any other needs that they might have via phone
Document all of your work
Must be able to type 45 wpm

Senior Clinical Administrative Coordinator Resume Examples & Samples

Assist members with selecting the best benefit plan options available to them through the enrollment process, including enrollment in specialized care programs
Resolve member service inquiries related to
Comfortable working Monday - Friday an 8 hour shift between hours of 7am – 8pm
1+ year of experience providing Telephonic Consulting
Experience working in the Healthcare Industry
Ability to multitask on a computer while working on the phone
Experience using Microsoft Office (Word, Excel, and Outlook)
Experience in a Call Center
Knowledge of HIPAA Regulations

Clinical Administrative Coordinator Resume Examples & Samples

1+ years of alpha/numeric data entry experience
1+ years of telephonic customer service experience
6+ months of experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
Ability to create, copy, edit, send, and save utilizing Microsoft Word
Ability to create, copy, edit, send, and save utilizing Microsoft Excel
Ability to create, copy, edit, send, and save utilizing Microsoft Outlook

Clinical Administrative Coordinator Resume Examples & Samples

1+ year of Experience working in a Call Center Environment taking Inbound Calls
Ability to create, edit, save and send documents utilizing Microsoft Outlook, Word and Excel
1+ years of experience with high volume inbound calls
Experience making outbound calls to members
Must be able to multi-task while working on multiple screen

Associate Clinical Administrative Coordinator Resume Examples & Samples

Works with pharmacy management to ensure daily production of Clinical Services programs including High Risk Profiling Service, Multiple Prescriber Service, Generic Conversion Service, Medication Review Service, and Drug Testing and Monitoring Service
Works with Clinical Support Specialist Supervisor, and other clinical services department members in entering data into HELIOS programs and computer interfaces to provide clinical services and measurement of clinical outcomes
Provides document support management of any electronic communication in order to meet client service agreements
Answers telephone calls, answers questions, or routes calls to appropriate personnel to provide telephonic support for customers
Reviews and implements any ongoing changes to operation of Clinical Services Programs
Works with pharmacy management on other responsibilities, special projects and initiatives as needed
2+ years of Customer Service experience analyzing and solving customer problems
Must be able to create, edit, save and send documents utilizing Microsoft Word, Excel, Adobe and PDF
1+ years data entry experience
Certified Pharmacy Technician

Clinical Administrative Coordinator Resume Examples & Samples

Assigns and reassigns members to appropriate Care Coordinator under the direction of the Care Coordination Manager
Accepts and inputs assessment and service plan information into databases
Communicates with external case managers on the phone
Updates Member demographic and placement changes in CareOne
Assists with administrative/enrollment activities for special programs
Assists with outgoing communication (calls/fax/email)
2+ years of professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
Experience using a computer and Microsoft Word, Excel, and Outlook
Knowledge and understanding of HIPAA
Experience working in a physician’s office or healthcare setting
Working knowledge of Medicare and/or Medicaid
Call Center Experience
Working knowledge of Medical Terminology/Coding (ICD-10 and CPT)
Experience with Electronic Visit Verification (EVV)
Experience with Microsoft Access, Project, and Visio

Clinical Administrative Coordinator Resume Examples & Samples

Extensive work experience with Medicaid community
Maintain 100% adherence to State contract, CMS requirements, and UnitedHealthcare Community Plan Performance and Quality metrics around goals
100% adherence to submission timelines of scheduled department reports, assigned metrics and state deliverables
100% adherence to submission deadlines on complaints
Meet State Partner and Internal expectation on timeliness & quality of interactions with members and providers
Demonstrate compliance in the urgency of all Star+Plus State & internal deadlines
Act as an advocate for membership and establish effective working relationships with our providers to service our members, ensuring all federal, state and company regulations, policies, and expectations are followed
High level of contact and interaction with regulatory agencies and various business segments to investigate and resolve complex issues
Utilize job aids/resources and critical thinking skills at all times to perform job duties
Timely response to care coordination team needs that are received via email
Collaborate with Service Coordinator staff to obtain case clarification, answer questions, case escalation
Escalate issues which cannot be resolved by team to Leadership
Provide clear and accurate documentation
Self-motivated/Self Starter
Organize work and develop strategies to adapt to constantly changing environment, while open to other job duties as assigned

Senior Clinical Administrative Coordinator Resume Examples & Samples

Process notification requirements
Customer material requests
Authorization for treatment
Verifying appropriate ICD-9 and CPT coding usage
Confirming Provider appointments
Processing referrals for durable medical equipment and referrals to specialist
Entering lab values
Enrollment of new patients into systems
Tracking hospital discharges
Faxing encounters to HBP’s
Faxing patient orders to vendors
Forward physician orders for signature
Notifies pharmacies of new prescriptions and authorizations of refills as ordered and/or authorized by the HBP
Participates in quality monitoring process
Demonstrates a high level of customer service behavior at all times
Patient Satisfaction Calls
Expedites emergency calls as needed
Attends regular staff meetings as scheduled
Maintains confidential health information according to state and federal regulations including HIPAA
Responsible to assist with gathering and organizing of appropriate medical records (e.g. history and physical, lab work, test results)
Filing and faxing
LPN Certification
3+ years of previous experience in Healthcare and Customer Service
Experience using a computer, keyboard and appropriate software to produce correspondence and function in a computer-based environment using Microsoft Outlook, Word and Excel
Ability to type 45-50 wpm
2+ years of Telephonic experience
2+ year of knowledge of HIPAA Compliance Requirements

Associate Clinical Administrative Coordinator Resume Examples & Samples

Billing and Payment issues
This position would answer phones and process requests for authorization as well as provide referral services for members seeking behavioral health services
Must be able to sit for a long period of time
6+ months of Call Center experience
6+ months of Customer Service experience
Must be able to create, edit, save and send documents utilizing MS Word and Excel
Previous Mental Health experience

Senior Clinical Administrative Coordinator Resume Examples & Samples

Cover the toll free quality intervention services phone line
Take calls from members, providers & other departments regarding clinical issues
Receive and organize email referrals
Confer with clinicians regarding cases
Research member eligibility and dates of service in regards to the cases
Create and send correspondence to the members regarding their cases
Enter all work into the database
Assign cases to clinicians for further investigation
Must be able to work Mon - Fri 8:00am - 5:00pm PST
2+ years of Customer Service experience analyzing and solving customer problems and concerns in a professional setting
1+ year of experience working within the Healthcare Industry
1+ year of experience working with Healthcare Insurance
Working knowledge of Medical Terminology to communicate with members and providers
Must be able to create, edit, save and send documents utilizing Microsoft Word and Outlook
Professional experience in a Clerical or Administrative support related role
Knowledge/experience with Medicaid, Medicare or Commercial

Senior Clinical Administrative Coordinator Resume Examples & Samples

Responsible for contacting clients and caregivers for the post-services survey process, gathering important feedback that contributes to our Net Promoter Score
Trained as back-up for our Intake team, speaking with clients and caregivers, gathering initial referral information
Complete and record quality review of all completed in-home assessments
Navigate between computer screens and platforms to research information
Take calls and questions from clients and care and/or providers regarding case status
Ongoing review of workflows and job aides to ensure correct and efficient processes are being followed
Respond to team requests for assistance with the database, shared drive or applications related to SFCG tasks
Provide assistance for routine inquiries directed to business analyst and intervene as needed or seek direction from business analyst and/or manager
Maintain shared drive
Secure appropriate meeting room reservations
Maintain and update team calendar, including clinician of day schedule
Documentation of information into relevant computer system
Complete final data entry of Summary and Recommendations of nursing visits
Oversight of materials library and ordering of replacements
Maintain and update as needed team resources
Working in a fast paced environment where you respond to needs of many people at the same time

Clinical Administrative Coordinator Resume Examples & Samples

Previous experience working with Microsoft Outlook, Word and Excel
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Services, Call Center environment
Experience with Lotus Notes

Clinical Administrative Coordinator Resume Examples & Samples

Must be able to work Monday - Friday 8:00am - 5:00pm in office; with occasional weekends and peak hours based on business needs
1+ years alpha/numeric data entry experience
1+ years of Call Center Customer Service experience
Must be able to create, copy, edit, send and save utilizing (Word, Excel, and Outlook)

Clinical Administrative Coordinator Resume Examples & Samples

Under the general direction of the Clinical Director or designee, provide Authorizations for Hospital Admissions, Skilled Nursing facilities, Rehabilitation facilities, Specialist Providers, Outpatient services and Ancillary services such as Home Health Care, Durable Medical equipment, Orthotics/ Prosthetic devices, Colostomy supplies and Infusion services, and others as directed
Assist in the coordination of Discharge Planning activities on all Plan participants. The Plan is dependent upon participants' Discharge needs
Communicate with a variety of Clinical disciplines to clarify and enforce Plan policies and procedures
Collect and review of service requests for completeness and referral to Clinical Director or Medical Director
Answer the telephone ACD line, as scheduled
Verify benefits in Diamond System
Referral filling and distribution to the designee coordinator
Referral processing for Outpatient services, including but not limited to Outpatient Surgeries, Rehabilitation Therapies, Radiation Therapy, Chemotherapy, Provider’s evaluations and Follow-up, Ancillary services, such as DME’s, HHC and Orthotics/Prosthetic devices
Collection of data for Clinical oversight
Pre-Authorization entering for Requests of services such as Clinical Evaluations/Follow-up visits, Outpatient procedures, Inpatient services such as: Elective Admissions, Emergency Room Admissions, Skilled Nursing facilities, Rehabilitation facilities, Outpatient services, Ancillary services, such as DME’s, HHC and Orthotics/ Prosthetic Devices in Diamond System, when applicable
Daily notification to PCP’S of Admissions Authorizations to Acute facilities. Authorization entering for Plan Members under the care of Dialysis and Hospice services
Process Denial Authorizations for non-coverage services for Medicare and Medicaid plan participant’s adherence to timeliness for determinations
Maintain and update daily reports as required, including but not limited to: Daily Hospital Admission Census, Skilled Nursing Facility Census, Rehabilitation Census, Part B Census, and Home Health Care Census
Maintain monthly reports for Dialysis, Hospice, Healthy Start, Medicaid Sterilization, Abortion and Hysterectomy, Re-admission to Acute facilities, Admissions to Acute facility and Telephone ACD Reports
Assist Case Managers and PCPs in the coordination of Discharge planning from Acute Facilities to Sub-Acute placements and from Skilled Nursing facilities and Rehabilitation facilities to Home and to Community services
Maintain record of Discharge planning implemented and coordinated services
Send Discharge Notification form with all discharge planning arrangements to PCPs upon discharge from facilities
Follow up with patient to assure accuracy that the coordination of services such as HHC and DMEs has been completed
Consult with various Clinical disciplines regarding specifics patient and their follow-up needs
Identify Risk Management issues thru Health Plan guidelines and requirements and submit Incident Reports to Director
Participate in monthly staff meetings
Participate in scheduled In-service for different disciplines
Perform Health Risk Assessment program
Ensure compliance with Risk Management policies and incident reporting
Assist with Health Risk Assessment data verification

Associate Clinical Administrative Coordinator Resume Examples & Samples

Ability to create, copy, edit, send and save utilizing Word, Excel & Outlook
Bachelor’s Degree or Higher, preferably in Behavioral Health or Social Services
Any Bilingual skills

Clinical Administrative Coordinator Resume Examples & Samples

Take calls from consumers in regards to cancer diagnosis
Determine if the consumers are eligible for a health program
Connect consumers to a nurse
Take calls from providers and enter services that they are requesting into the system
Must have accurate documentation
Must meet weekly metrics

Clinical Administrative Coordinator Resume Examples & Samples

1 + year of experience working in a Hospital, Physician's Office, or Medical Clinical setting
1 + year of working knowledge of Medical Terminology
1 + year of experience working with ICD-10 and CPT codes
1 + year of Insurance Verification and Eligibility experience
Must be able to work a flexible shift from 4:00am-6:00pm and work weekends if that is what the business calls for

Clinical Administrative Coordinator Resume Examples & Samples

Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers through outbound calls in response to inquiries received
Review requests for approval notification and processing notification requirements
Assist the clinical staff with processing, updating and setting up documents and/or triage cases for Clinical Review
1+ years of customer service experience analyzing and solving customer problems
Ability to utilize multiple screens and software programs in order to conduct daily tasks
Ability to navigate a PC to open applications, send emails, and case creation
2+ years of Benefits, Special Plan Documents (SPDs) Review experience
Experience with Infertility Case and Diagnostics review
Experience working with ICD-9, ICD -10 and CPT codes
Experience working with a virtual team
Fast-learner capabilities when learning new technologies

Clinical Administrative Coordinator Resume Examples & Samples

Assures peer reviews are scheduled with appropriately licensed MD based on a number of factors within expected turnaround times
Contacts treating facility to determine attending MD availability
Determines if MD availability is exhausted so that review can be sent for external MD organization
Completes and submits external reviewer form including clinical summary taken from member's record
Processes external review clinical reports to assure sign off within required turnaround time and by appropriately licensed MD
Is logged into and answers Queue line calls
Identifies scheduling issues and discusses solutions with senior or supervisor
Responds to questions from internal and external parties involved in the scheduling process
Must be able to work any shift M-F 7am - 6pm CST
5+ years of Customer Service experience
Scheduling experience within a Clinical or Business setting
Experience applying specific policies or standards to daily work to assure compliance with relevant regulations
Ability to navigate a computer and Windows including Microsoft Word and Excel
Experience analyzing patient records
Experience working in a mental health/substance abuse facility
Direct experience scheduling peer reviews or working with healthcare regulatory and compliance issues
Knowledge of HIPAA compliance
Previous experience with benefits and medical terminology
Experience working with ICD9/CPT codes

Senior Clinical Administrative Coordinator Resume Examples & Samples

Comfortable working Monday - Friday normal business hours
Experience working with Medicare and/or Medicaid
Experience working in a Medical Clinical setting
Referral intake process experience

Clinical Administrative Coordinator Resume Examples & Samples

Take incoming calls from external customers regarding appeals
Return calls from external customers regarding appeals
Document the content of your calls in a database
Create letters to send out to the external customers utilizing the clinical software
Send and receive multiple faxes from external customers and providers
Collaborate with internal partners and team
Adhere to strict turnaround time per policies and procedures
Prioritize and multi task based on workload and business need
Ability to work in a fast paced, compliance driven environment
Adherence to companies Policies and Procedures
Option of on-site or telecommute, will be determined upon completion of training
2+ years of proven Customer Service experience
1+ years of experience in an office setting/telecommuter environment using the telephone and computer as the primary instruments to perform the job duties
Ability to navigate a computer, Microsoft Office products including Excel and Word, and windows PC Applications, with the ability to learn new and complex computer system applications with proper training and apply their use for phone and off phone duties
Monday-Friday 8am-5pm CST with weekends, holidays, and OT depending on business needs
Bachelor’s degree, Vocational Technical degree in Healthcare or some College credits
Experience working in a remote/virtual environment
Medicare working experience
Knowledge of ICD 10 and CPT Codes
Must have clear verbal and written communication

Clinical Administrative Coordinator Resume Examples & Samples

Make calls to Providers and Enrollees
Resolve Customer Service inquiries which could include: Entering notifications, Providers' status of an existing notification, and determining if notification is required; and providing excellent Customer Service to both Providers and Enrollees
Experience using a computer and Microsoft Office (Word, Excel, and Outlook) with the ability to work in multiple systems and programs at once
Ability to type at least 30 WPM with a high-level of accuracy
Must be able to work Tuesday- Saturday 8am-5pm
Professional experience in the healthcare field or with insurance benefits
Professional experience with Medical Terminology/Coding (ICD-9/10 and CPT)

Clinical Administrative Coordinator Resume Examples & Samples

Ability to use a Windows PC and utilize multiple applications
1+ year of Clerical or Administrative experience
Experience working in Healthcare Industry
Experience working with Health Insurance
Experience working in a Hospital, Physician's Office or Medical Clinic environment
Working knowledge of ICD-10 and/or CPT Codes
Experience with Medicaid and Medicare Services

Clinical Administrative Coordinator Resume Examples & Samples

Make outcome provider and enrollee calls
Review notifications and determine if needs clinical review, if clinical review request clinicals from provider and follow up as needed
Review clinicals for completeness before sending
Professional experience in the areas of Healthcare or Insurance Benefits

Clinical Administrative Coordinator Resume Examples & Samples

Outbound phone calls to members advising of status of prior authorizations that were submitted
Agent will be responsible for HIPAA verifying each member, documentation and ability to maintain metrics
Must be able to accommodate for mandatory overtime
Flexibility to work an 8 hour shift between the hours of 6:00am-7:00pm Monday through Saturday
Ability to create, edit, save and send documents utilizing Microsoft Word and Microsoft Excel
Flexibility to work an 8 hour shift between the hours of 6:00 am - 7:00 pm Monday through Saturday
Letter Writing experience
Familiarity with both State and Government guidelines

Clinical Administrative Coordinator Resume Examples & Samples

Complete notification wizard along with ICD-10 and CPT coding
Would like the candidate to have medical insurance or provider office experience as either a claims examiner, customer service rep or in front office
2+ years of professional experience in an office setting performing Data Entry and making outbound calls
Previous experience in a Clerical or Administrative role
Previous experience with Microsoft Excel, Word and Outlook
Experience in Claims background or Medical Management
Medical Terminology and Coding (ICD-10 and CPT) experience

Clinical Administrative Coordinator Resume Examples & Samples

Requesting clinical information from Nurses/Providers facilities
Tagging records
Documenting in the system once records are received
Pulling reports in MS Excel
Creating word docs in MS Word
Support BSL if needed, ordering equipment
Work on special projects, as needed
2+ years of experience working within the Healthcare Industry
Proficient with Microsoft Word and Excel. Must be able to create, edit, save and send documents utilizing Microsoft Word and Excel
Must have hard wired high speed internet connection
Must live near a UHG office and be commutable to a UHG office
Comfortable working Monday-Friday from 8:00 am - 5:00 pm
Must be on MST or PST time zone

Senior Clinical Administrative Coordinator Resume Examples & Samples

Ability to travel up to approximately 25% of the time within the local area to provider offices
1+ years of experience providing Telephonic Consulting or Counseling in the Medical field
Experience with Microsoft Word and Outlook, with the ability to navigate within a Windows environment
Bilingual fluency in English and Arabic or English and Spanish

Senior Clinical Administrative Coordinator Resume Examples & Samples

Identify nursing staffing needs
Resolve Customer Service inquiries which could include
Must have an LVN OR Pharmacy Technician License
3+ Years of Infusion Therapy and Home health experience with specific proficiency in infusion therapy
Previous experience with EMR
Experience in areas of Insurance Benefits or Healthcare
Experience in using Microsoft Windows based PC skills (this includes Word, Excel, and Outlook)
Good communication, verbal and written skills

Clinical Administrative Coordinator Resume Examples & Samples

Prior experience with home infusion therapy is preferable, especially benefits verification and obtaining authorization
Electronic Medical Records experience is preferable
Electronic Medical Records experience (EMR)

Clinical Administrative Coordinator Resume Examples & Samples

Track received data and source documents
Compile, sort, interpret and verify data to be entered into data base
Enter alpha/numeric data from source documents into a computer following the format displayed in the screen
File and route source documents after entry as appropriate
Respond to inquiries regarding data
Work directly with providers to obtain data
Work directly with members in regards to Healthy Michigan Plan applications
Prepare routine mailings
6+ months Professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties
Experience using Microsoft Outlook, Word and Excel
Facets or Macess experience
Experience working in telephonic customer service environment

Clinical Administrative Coordinator Resume Examples & Samples

Experience with ICD-10 and CPT codes and the ability to determine the difference between these codes
Experience working in a call center environment (75+ calls per day)
Experience working in a Physician's Office, Medical Clinic, or Hospital environment
Available to work occasional overtime
Healthcare Insurance experience
Experience working with Medicare/Medicaid services
Experience using Microsoft Word (create, edit, save, and send documents), and Excel (data entry, sort/filter functions) in a professional environment
Ability to use a Windows PC and use multiple applications at the same time

Clinical Administrative Coordinator Resume Examples & Samples

Flexibility to work an 8-hour shift between the hours of 6:00 am - 7:00 pm Monday through Saturday
Letter writing experience
Familiarity with both State and Government Guidelines

Clinical Administrative Coordinator Resume Examples & Samples

1+ years of professional experience in an office/Customer Service environment
Previous experience working with a computer including, but not limited to, ability to learn new computer system applications
Must be able to work Monday - Friday 8am - 5pm
Professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties OR Customer Service experience analyzing and solving customer's problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and/or Medicaid Services, call center environment
Must be a self-starter and able to work autonomously

Clinical Administrative Coordinator Resume Examples & Samples

Provide excellent Customer Service to both providers and members by responding to and resolving incoming inquiries and requests
Consistently meet established productivity and quality standards while adhering to schedules and maintaining good attendance
Receive Care Coordination notifications for non-clinical assessment/intervention and provide appropriate triage. Approve when able and send to clinical reviewer when unable
Process notifications for outpatient procedures, home health, DME, transition of care, and network gap issues
Depending on product, process out-of-network requests for consideration of in-network level of benefits for physician specialty referrals
Determine benefit coverage based on employer group contracts
Communicate benefit determinations to providers/members within DOL timeframes
Process letters within DOL timeframes
When relevant, ensure potential member needs are identified and forwarded to the appropriate Care Coordinator for risk evaluation - refer to CM and DM as relevant
Verify appropriate ICD-10 and CPT coding usage
Assist with processing of faxes and emails, including sending provider “fax forms” for certain clinical scenarios as designated
Make outbound calls to contact Providers, requesting clinical from provider as necessary
Take inbound calls to provide status of cases from providers
Ensure case requires PA, is “scrubbed” prior to sending to clinical reviewer, and includes all necessary components
Take inbound calls from providers requesting a Peer-to-Peer discussion, prep requests for Peer-to-Peer discussions with Medical Directors, and assign them in Aerial
Confirm urgent versus non-urgent
Prioritize and organize own work to meet deadlines while working with others as part of a team
Cooperate with all members of CCR staff to ensure compliance with standards and regulations
Work with other departments to ensure appropriate handling of customer requests
Use knowledge and judgment to escalate complex problems to supervisor when necessary
Perform other duties as assigned by manager and/or director
Ability to utilize Microsoft Word and Excel with proficiency
2+ years of professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties OR 2+ years of Customer Service experience analyzing and solving customer's problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, Insurance, ICD-9 and CPT codes, Medicare and/or Medicaid Services, call center environment
Ability to run multiple computer systems and programs at the same time

Clinical Administrative Coordinator Resume Examples & Samples

EPSDT and Immunizations appointments
Lead Screenings
Well Child Visits
Comprehensive Diabetic Services
Prenatal and Postpartum
Well Woman Services
Adults and children with physical or development disabilities
Other HEDIS/HEDIS like measures and projects as assigned
25% Travel within the surrounding counties
2+ years PC skills including Microsoft Office
2+ years of Customer Service experience analyzing and solving customer problem
Experience working with Medicare and/or Medicaid Service
Experience working within the Healthcare Industry including, but not limited to, a Hospital, Physician's Office or Medical Clinic setting

Clinical Administrative Coordinator Resume Examples & Samples

Respond to incoming Provider calls
Enter notifications and Provider's status of an existing notification and determine if notification is required
Provide excellent Customer Service to Providers
Current experience using a computer and Microsoft Word (creating/editing documents), Excel (working with/editing spreadsheets), and Outlook (email)
Comfortable with a Monday through Friday work shift during core business hours including at least one late stay per week and overtime as needed
Hospital, Physician, or Medical/Clinical experience
Coding (ICD-9 or CPT) experience
Healthcare/Insurance Benefits experience
Professional experience in an office setting using the telephone and computer as primary instruments
Professional experience in a Clerical or Administrative role

Clinical Administrative Coordinator Resume Examples & Samples

Comfortable working Monday-Friday 8 hour shift from open between 6:00 am - 6:00 pm
2+ years of experience in an Office setting environment using the computer as the primary instrument to perform job duties
1+ year of Data Entry experience with proofreading skills

Clinical Administrative Coordinator Resume Examples & Samples

2+ years of professional experience in an Administrative setting using the telephone and computer as the primary instruments to perform the job duties OR 2+ years of Customer Service experience analyzing and solving customer’s problems
Previous experience working with Microsoft Word, Excel and Outlook
Ability to type at least 40+ wpm with a high-level of accuracy
Must live in Arizona

Associate Clinical Administrative Coordinator Resume Examples & Samples

1+ years of Customer Service experience analyzing and solving customer’s problems
Available to work from 8:00 am to 5:00 pm and weekend overtime as needed
Experience working with ICD-10 and CPT Codes
Previous Call Center experience

Clinical Administrative Coordinator Resume Examples & Samples

Resolve customer service inquiries which could include
Enter notifications, Providers status of an existing notification and determining if notification is required
Experience preferred with processing UM requests. Skills with providing Public sector customer service

Clinical Administrative Coordinator Resume Examples & Samples

Take repeated live calls from providers
Review prior authorizations for outpatient & inpatient services
Build prior authorization cases with accuracy
Communicate with nurses & other interdisciplinary departments via phone
2+ years of customer service experience
1+ years of experience working in a call center environment
Available to work an 8 hour shifts between 10 am - 8 pm, Monday through Friday
Experience working with healthcare insurance
Working knowledge of medical terminology to communicate with members and providers
Ability to type and talk at the same time

Associate Clinical Administrative Coordinator Resume Examples & Samples

Extensive work experience within own function
May coordinate others activities
Must be available 40-hours a week, Monday - Sunday 7:00 AM – 5: PM
1+ years of experience working within the Healthcare Industry
Working Knowledge of Medical Terminology to communicate with members and providers
Previous Call Center Environment Experience
Healthcare insurance experience

Clinical Administrative Coordinator Resume Examples & Samples

2+ years of professional experience in an office/Customer Service environment
Previous experience working with Microsoft Word, Excel, and Outlook
Must be able to work between the hours of 8:00am - 7:00pm, flexible schedule Monday - Saturday
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD and CPT codes, Medicare, Medicaid Services, and/or Call Center environment
Experience in a Medical office billing or Medical Assistant/Clerk

Clinical Administrative Coordinator Resume Examples & Samples

Member Mailing
QA reporting
State reporting
Previous experience working with Microsoft Word and Excel
Experience working with ICD-9 and ICD-10 and CPT codes

Clinical Administrative Coordinator Resume Examples & Samples

Telephonic outreach including direct member and provider call 3 way appointments
Participation on UHC's Member Consumer Advisory Board
Collaboration with Local Health Departments, FQHCa, School Based Health Centers and State Agencies
Community events and health fairs
Bulk appointment with provider collaboration
Develops effective relationships with provider office, other contracted services, management, peers and co-workers
Provide expertise claims support by reviewing, researching and investigating all types of preventive and clinical claims to ensure members received appropriate critical measures
Obtain information from providers on critical measure requests for year round initiative and medical record review
Develop and maintain business relationships with provider offices
Provider added values to Practices through onsite appointment scheduling
Educate member and practices on the member incentives offered for targeted services
Work as a liaison between the heath department, school based health center or providers office to ensure member receive appropriate care
Maintain records, reports and statistics
Completion of special projects (as assigned)
Document all outcomes
Knowledge of United Healthcare claims processing systems
Bi-lingual (English and Spanish)

Associate Clinical Administrative Coordinator Resume Examples & Samples

Entering notifications and Providers' status of an existing notification, and determining if notification is required
Previous Healthcare experience
Experience with Healthcare Customer Service or a Medicare and/or Medicaid environment
ICD-10 and CPT Coding experience
Experience with Long-Term Care or Support Services
Experience with Medicare/Medicaid

Senior Clinical Administrative Coordinator Resume Examples & Samples

3+ years of experience in a Healthcare environment (Physician’s office, Hospital or Health Insurance) is required
Must be able to create, edit, save and send spreadsheets utilizing Microsoft Word and Excel
1+ years of experience working with ICD-10 and CPT Codes
2+ years of Telephonic or face-to-face Customer Service is required
FACETS experience

Senior Clinical Administrative Coordinator Resume Examples & Samples

Working closely with Nurses
Handling referrals that come in with nursing needs
Must have an LPN License
Ability to create, edit, save and send documents utilizing Microsoft Word and Excel

Clinical Administrative Coordinator Resume Examples & Samples

2+ years of experience working in a clerical, administrative support, or similar role
1+ year Telephonic Customer Service experience
Ability to type at least 40 WPM
Must live within a 60 mile radius of an Optum office
Call Center with high volume
Medicare and/or Medicaid knowledge
Experience in a Hospital, Physician's Office, Medical/Clinical, or Health Insurance background

Clinical Administrative Coordinator Resume Examples & Samples

Documents all patient interactions completely, accurately, and in a timely manner
Receive and responds to incoming Care Coordination inquiries from all communication channels e.g. phone queue, department e-mail box or faxes
Coordinates and assist in scheduling initial LTC appointments for new and existing enrollees
Provides clerical and/or administrative support to clinical staff and managers
Provides excellent customer service by serving as a resource to all internal and external customers
Maintains knowledge of all health plan benefits, network, CMS, regulations and health plan policies
Maintain confidentiality and adhere to HIPAA requirements
*NY Telecommute, must reside in NY to be considered***
Experience working with ICD-9/ICD-10 and CPT codes
Previous experience working as a telecommuter

Clinical Administrative Coordinator Resume Examples & Samples

Must be able to work 8 hour shifts between 7 am - 7 pm CST, M - F
6+ months of experience working in a high volume call center environment taking inbound calls
Must be able to multi-task while working on multiple screens

Senior Clinical Administrative Coordinator Resume Examples & Samples

Coordination and collaboration of care for home infusion patients with all associated departments
Assist nursing with management of nursing schedules
Work with the junior level staff to insure metrics are met
1+ years of experience working with chronically ill patients
1 + years experience in areas of Insurance Benefits or Healthcare
Bachelor’s Degree (or higher)
Active Pharmacy Technician license
Experience with coordination/scheduling of Home Influsion care

Clinical Administrative Coordinator Resume Examples & Samples

Involved in the nightly and weekend on call rotation
Experience working in a physician's office, hospital or medical clinic environment
Professional experience in a clerical or administrative support role
Experience working with ICD-10/CPT codes
Experience working with Medicaid/Medicare Services

Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative intake of members and/or providers information post notification
Assist the clinical staff with setting up documents/triage cases for Quality Review
Microsoft Access experience

Clinical Administrative Coordinator Resume Examples & Samples

Gathers patient information accurately and completely by utilizing appropriate templates in CPR+
Verifies insurance eligibility prior to processing order
Assembles patients electronic medical record accurately and completely and manages documents appropriately in CPR+
Process orders in a timely manner
Obtains necessary information according to Joint Commission (JCAHO) guidelines
Obtains authorization for services
Informs Clinical Teams of referrals and updates them on the status of the case
Prepares pending files by utilizing appropriate templates in CPR+
Communicates/Coordinates referrals with outside pharmacies and referral sources
Understands diversity of contracts to handle referrals accordingly
Coordinates the start of care with the patient/caregiver, referral source, and other providers of care
Coordinates time and initial delivery
Cancels pending/no-go referrals when appropriate
Documents patient related activities/information in the patients electronic medical record
Consults with direct Manager on difficult or unusual referrals, as appropriate
Maintains confidentiality of patient and company information
Complies with all company policies and procedures
Gathers and ensures all necessary documentation for chart is obtained
Communicates effectively with Clinical Team members to assure a smooth transition from intake to start of care
Monitor MY Fax for incoming information and printing information
Check electronic discharge websites for new referrals and updated information, as required
Send the initial referral email to sales/onsite to confirm receipt of the referral
Formulate and negotiate private pay pricing as per limitations set by company
Scans and appropriately label patient documents in CPR+

Clinical Administrative Coordinator Resume Examples & Samples

1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform the job duties
Monday-Friday 8am-5pm with weekends, holidays, and OT depending on business needs
Bachelor’s degree (or higher), Vocational Technical degree in Healthcare or some College credits

Senior Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative intake and data entry for clinical team of membership
Work with providers and/or the clinical team to manage request for long term and respite services
Manage notifications, processing incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
Receive care coordination notification cases for non-clinical assessment/intervention and provide appropriate triage
Process and distribute custom reports to providers and clinical staff
Multitasking with multiple platforms and applications
Inbound/outbound phone calls to providers other internal departments to assist with notifications, documentation
1+ year of experience using the telephone and computer as primary instruments
2+ years of healthcare administration / Healthcare research administration experience
Experience utilizing a PC computer to navigate different computer systems and experience utilizing Microsoft Excel, Word, and Outlook to perform job functions
Claims and/or healthcare insurance experience

Clinical Administrative Coordinator Resume Examples & Samples

Manage the intake of members or the admission/discharge information post notification
Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention
2+ years experience working within the Healthcare Industry
1+ years experience working with Healthcare Insurance
Experience working with ICD-9, ICD-10 and CPT codes

Clinical Administrative Coordinator Resume Examples & Samples

Receiving, initiating and validating all incoming cases
Performing initial case processing
Preparing correspondence with the patients and providers
Generating some referrals
Initial triage of members
Administrative intake of members
Managing the admission/discharge information post-notification
Working with hospitals and the clinical team
Managing incoming calls,
Managing requests for services from providers/members,
Providing information on available network services
Transferring members as appropriate to clinical staff
Manages the referrals process, processes incoming and outgoing referrals
Requesting services and forwarding to nursing staff when appropriate
3+ years of Telephonic Customer Service
Must be able to create, edit, save and send documents utilizing Microsoft Word and Excel and Outlook
Experience using Medical Terminology
Health Care Insurance experience
Ability to balance multiple projects at once is a must

Clinical Administrative Coordinator Resume Examples & Samples

Review and process fax and telephone requests to meet department key indicator productivity and accuracy standards; maintain minimum of 95% case data entry accuracy
Follow department policy regarding accurate documentation of clinical data, demographic and product information, provider/facility contract status, appropriately route cases to RN for clinical review, follow departmental policy for non -clinical level notifications
Maintain 100% accuracy of letter generation within compliance time frames
Provide high level of customer service while communicating with internal departments and provider office staff as pertains to performance of job responsibilities
Takes responsibility for problem solving to achieve key indicator goals
6+ months Medical Terminology experience
6+ months of Heavy Phone experience (Call Center, Front Desk or Switchboard)
ICD-10 and CPT codes experience
Experience working in a Healthcare Facility, Medical office, Hospital or Managed Care setting

100

Senior Clinical Administrative Coordinator Resume Examples & Samples

Work with hospitals, clinics, facilities and the clinical team to assist during the HEDIS season
Previous Project Management Experience
Claims Experience
Citrix Experience
Previous Quality / NTAQ Experience

101

Clinical Administrative Coordinator Resume Examples & Samples

Monitor timely receipt, accuracy and compliance of State assessment
Maintain 100% adherence to State contract, CMS requirements, and UnitedHealthcare Community Plan Performance and Quality metrics around Nursing Facility Goals
Adherence to submission timelines of scheduled department reports, assigned metrics and state deliverables
Adherence to submission deadlines on complaints
Be responsive to our members (retention & referrals) and providers (contracting retention)
2+ years of Clerical or Administrative work experience
2+ years of experience using the telephone and computer as primary instruments to perform job duties
Comfortable working Monday-Friday from 8am-5pm with OT as needed

102

Senior Clinical Administrative Coordinator Resume Examples & Samples

Verifying appropriate ICD-10 and CPT coding usage
2+ years of experience working in a clerical or administrative support related role
Previous experience working with Microsoft Outlook, Word and Excel (must be able to create, edit, save and send documents)
Previous experience working with PCs (must be able to navigate a PC to open applications, send emails, and conduct data entry)
Experience working within the healthcare industry (ie. Hospital, Physician's Office, or Medical Clinical setting)

103

Clinical Administrative Coordinator Resume Examples & Samples

Manage multiple methods of census notification
Manage the multiple products and lines of business in the appropriate UM systems
Receive admission notifications for current, future, and retrospective admissions from facilities and/or Inpatient Care Managers (ICMs)
Manage cases for shared risk, fully insured, partial risk carve-out, and OOA acute inpatient, skilled nursing, AIR and LTAC admissions, in the appropriate UM system
Utilize the Blended Census Report (BCRT) to identify cases requiring updates and/or correction
Route Priority Review inpatient cases from Intake to ICM within 60 minutes
Update every acute case on a daily basis from the BCRT from the following information
IPC faxes or calls facilitie
S requesting discharge dates
IPC takes the information from the hospital census/discharge reports
IPC receive the information from the ICM updates/corrections that have been emailed to the department mailbox
Entry of all discharge dates to any case regardless of owner
CDU owned cases closed per the PR process
ICM owned cases discharged before able to perform clinical review
Issue admission notification letter as required
Capture timely discharge date and case closure, within 24 hours of discharge
Focus on data integrity and accuracy for multiple downstream dependencies
Accurate bed day reporting utilizing notification data initially
Timely and accurate UM system(s) census reporting for clinical staff – Onsite/Telephonic Nurses and MDs
Support all the guidelines to the Priority Review Criteria for Acute and SLOC
Accurate diagnosis capture to support such programs as Disease Management, Case Management and facilitate accurate reporting
Generate referrals to Welcome Home, NRS and other applicable Optum Programs.- Foster collaborative working relationships with facilities, venders, medical groups, and internal clinical staff - Orient new and existing facilities to the notification requirements/process.- Adhere to a work schedule to that of Intake and to meet the needs of the clinical staff and maintain census timeliness
Maintain the goal of 95% authorization to claims bed day data capture and meet the TAT goal of routing PR and SLOC cases from Intake to Nurse within 60 minutes
Provide feedback to the CDU management team regarding census submission issues from the facilities
Identify new workflow processes and/or modification to existing processes as appropriate to meet program requirements, and increase/maintain member and provider satisfaction
Follow UM application specific SOPs for data entry and workflow consistency
Make timely case corrections based on the Health Care Economics Exception Reports
Meets expected quality and productivity standards
Ability to manage and prioritize multiple tasks
Demonstrates critical thinking and decision making skills
Functions well in a team environment. Acts as a team player and is accountable to the team for helping to meet all goals/objectives

104

Clinical Administrative Coordinator Resume Examples & Samples

HEDIS overview
Policy and procedure maintenance
QI plan, UM plan and Program Eval maintenance
Administratively support the Quality/Compliance Team
Use of computer applications, including databases and spreadsheets
2+ years of experience in administrative or clerical role and successful ability to perform administrative tasks
2+ years of healthcare and/or insurance customer relations
1+ year of experience in quality assurance/quality improvement
2+ years experience using MS Word, Excel, and Outlook
MS Access experience
Claims processing experience
Experience in statistics and/or analytics
HEDIS knowledge and/or experience
URAC, NCQA and/or CMS knowledge and/or experience
Close attention to detail - in an effort to eliminate errors
Problem solving abilities - analytical, thinking outside of the box

105

Clinical Administrative Coordinator Resume Examples & Samples

Associate Degree or higher OR High School Diploma/GED and 2+ years of healthcare insurance experience
Comfortable working an 8-hour shift, Monday through Friday, between the hours of 6am to 6pm
1+ year of experience in an office environment using a computer as the primary instrument to perform job duties
6+ months of experience working in a professional team environment
Experience working with Microsoft Word, Excel, Outlook, and utilizing the Internet
Healthcare or healthcare insurance experience
Ability to proofread documentations

106

Clinical Administrative Coordinator Resume Examples & Samples

Able to work Monday-Friday from 8am-5pm
Ability to create, copy, edit, send & save utilizing Microsoft Word, Excel & Outlook
Must live within a 60 mile radius of Maryland Heights, MO office location
Prior experience with letter writing / templates

107

Senior Clinical Administrative Coordinator Resume Examples & Samples

Handle resolution/inquiries from members and/or providers
Self-starter with good follow-through who can work independently in managing workload and takes initiative to overcome obstacles that might prevent servicing a patient
Comfortable working an 8 hour shift between hours of 7am-8pm Monday-Friday with OT and weekends possible based on business needs
6+ months of customer service experience analyzing and solving customer problems
6+ months of professional experience in a clerical or administrative support related role

108

Clinical Administrative Coordinator Resume Examples & Samples

Assign referrals to Case Management staff
Respond to incoming provider and enrollee calls; Enroll members as appropriate
Established effective productivity standards and schedule adherence
Assist with faxes, mail, voicemail management and other duties as assigned
Must be able to work in a production environment, independently
Maintain the ability to handle multiple tasks and competing priorities
Document case information completely, accurately and in a timely manner
Be able to work in team oriented environment
This is a LOCAL telecommute (near Greensboro) opportunity after office training
Must be able to work an 8-hour shift between the hours of 9:00 am - 6:00 pm, Monday through Friday
2+ years of professional experience in a Clerical or Administrative role within the Healthcare field
1+ years of experience in an office environment using the telephone and computer as the primary instruments to perform job duties
Ability to maintain HIPAA Requirements
Ability to navigate a PC environment and utilize Microsoft Office (Word, Excel, Outlook) in a professional environment
Professional experience with Medicare
I-CUE Application and/or My Health Direct experience
Experience in the Healthcare field

109

Associate Clinical Administrative Coordinator Resume Examples & Samples

Call Medicare members to schedule appointments with Pharmacist to review their prescriptions under our Medication Therapy Management Program
Explain what the member can expect when they talk with a pharmacist
Answer questions and address any concerns by talking through some of the benefits of talking with the pharmacist
Create and maintain Pharmacists schedules
Achieve performance standards
Comfortable working Monday-Friday an 8 hour shift between 8am-6:30pm CST
1+ year of Healthcare experience
1+ year of customer service or call center experience
Experience working with Medicare population

110

Clinical Administrative Coordinator Resume Examples & Samples

Associate Degree (or higher) OR High School Diploma/GED and 2+ years of healthcare insurance experience
1+ years of experience in an office environment using a computer as the primary instrument to perform job duties
Ability to proof read documentations

111

Clinical Administrative Coordinator Resume Examples & Samples

Review member medical cases
Assign member cases to the field based Community Health Workers
Document all work accurately

112

Clinical Administrative Coordinator Resume Examples & Samples

Good working knowledge of systems used for processing of QOC cases
QCare and legacy QOC tracking applications
Microsoft applications (Outlook, Word in particular)
Demographic systems (such as Facets, MACESS, UNET/COSMOS, NDB, etc.)
Auto correspondence application
Able to effectively utilize UHG applications related to QOC case research, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems
Order medical records and/or response for clinical reviewer (including working with copy services as needed and timely follow-up)
Good verbal communication skills with provider contacts
Support clinical staff in case closure within 3 business days
Support clinical staff with QOC Inquiry correspondence within 1 business day. (includes fax to involved provider, merge fax confirmation with soft copy of Inquiry letter and save in document storage application; and complete timely phone FU for response)
Interface with other departments as needed (i.e. A & G, UHN, etc)
Acceptable workload determined to be 40 - 45 cases/month, per workforce tool
Request medical records within 1-3 business days of TA/RN request for records
Follow-up phone call made 10 business days after initial record request
Thoroughly document activity (e.g. document case follow-up and receipt of requested information per department processes)
Maintain accuracy and thoroughness in primary QOC applications data entry
Ensure correspondence is accurate and grammatically correct
Discuss and document case status with RN by day 40 for QOC cases if incomplete submission of records
Upload/maintain/store all relevant case investigation related documents electronically per designated document storage application (QCare)
Call Center experience with high volume

113

Clinical Administrative Coordinator Resume Examples & Samples

Open member cases from referrals sent via either e-mail, fax, spreadsheet or SharePoint site
Insert benefit and eligibility information into referral case as appropriate
Transfer these cases to the appropriate product specific work queue
Assign referral cases to the product specific Clinical Consultant/Case Manager based on product specific guidelines
Healthcare Insurance Industry experience
Experience with transplant services
Previous experience working with SharePoint

114

Clinical Administrative Coordinator Resume Examples & Samples

Pulling reports
Managing the work queue
Answering emails
Setting up/hosting WebEx meetings
Taking meeting minutes
Making outbound calls to members
Assist with onboarding new hires
1+ years of telephonic customer service experience, or 1+ years of clinical experience (as a CNA, Medical Assistant, etc)
1+ years of Healthcare experience
Experience using a computer and Microsoft Office (Word, Excel, Outlook, and PowerPoint)
Available to work possible overtime
Ability to travel up to 5% of the time for training events, etc
Certified Medical Assistant or Certified Nursing Assistant

115

Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative intake of members or the admission/discharge information post notification. Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and/or providers
1+ years of PC experience - must be able to open applications, send emails, and conduct data entry
Experience using MS Office - Word, Excel and Outlook
Prior Healthcare experience
Previous clerical or administrative experience

116

Senior Clinical Administrative Coordinator Resume Examples & Samples

Responsible for verifying members eligibility, level of care placement, ensure member meets all qualifications for services being requested
Responsible for working up cases, reviewing, decision making and coordinating services with the HCBS UM Review Nurses
Responsible for meeting turnaround timelines
Manages incoming communication calls/fax/email/tasking group - members/providers
Comfortable working Monday-Friday from 8:00am-4:30pm
1+ years of Medicaid experience
Experience using a computer to open applications, send emails and conduct data entry
Medical/Healthcare experience
Experience with Medical Terminology and ICD-9/ICD-10 Coding
Medicare experience
Call center experience (high volume preferred)
Experience working with HIPAA Requirements
Bilingual with any language

117

Senior Clinical Administrative Coordinator Resume Examples & Samples

Engage members either face to face and over the phone to educate about their health
Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care)
Conduct comprehensive member assessment that includes bio-psychosocial, functional, and behavioral health needs
Identify when supplemental assessments are needed and conduct supplemental assessments
Identify member service needs related to health concerns
Identify urgent member situations and escalate to next level when necessary
Engage member to participate in the assessment process and collaboratively develop plan of care based on their individual needs, preferences, and objectives with nursing oversight
Work with members to develop healthcare goals and identify potential barriers to achieving healthcare goals
Comfortable working Monday-Friday 8 hour shift between hours of 7am - 7pm, overtime possible depending on business needs
CPR Certification or the ability to obtain within 30 days of hire
High Risk Maternity and/or High Risk OB experience
Must have resided within the community for 1+ years
Bachelor's Degree (or higher) in Social Work and/or Health Care Administration
Experience working in the Behavioral field with Substance Abuse and/or Mental Health
Experience working in managed care
Knowledge of Nevada Medicaid & Medicare population
Working experience in a medical office or other provider environment
Knowledge of Medicaid health care and insurance industry
Experience working within the community health setting in a healthcare role
Field based experience
Familiarity with the resources available in the community

118

Clinical Administrative Coordinator Resume Examples & Samples

Responsible for initial triage of provider calls, administrative intake of prior authorization requests, working with providers and the prior authorization and utilization management team
Managing incoming calls, managing requests for services from providers, providing information on available network services and transferring members as appropriate to utilization management staff
Processes incoming prior authorizations and uploads files into the applicable system
Triages member appeal calls
1+ year of telephonic customer service experience
Medicaid knowledge/experience

119

Clinical Administrative Coordinator Resume Examples & Samples

1+ years of experience in a Healthcare Administrative role
Ability to create, copy, edit, send, and save utilizing Microsoft Word, Microsoft Excel, and Microsoft Outlook
Ability to travel up to 5% of the time (locally)

120

Clinical Administrative Coordinator Resume Examples & Samples

Work on claims issues with members and providers via telephone to make determinations
Process request letters asking for additional information
Send out approval or denial letters to members and providers once determinations are made
Demonstrate medical plan knowledge when communicating with members
The demonstrated ability to read and understand a medical insurance plan document
CPS Claims processing experience
Previous experience working with a computer and windows PC applications as well as the ability to utilize Microsoft Office (Outlook and Word) in a professional setting
UMR Claims Processing experience

121

Clinical Administrative Coordinator Resume Examples & Samples

Filter reports
Will be confirming member information by way of various internal systems to identify and validate member information
Utilize critical thinking, analytical skills and research abilities to formulate results
2+ years of Data Entry experience
1+ years of experience working within the Healthcare Industry and utilizing Medical Terminology
Experience editing, updating, uploading, downloading, and saving documents using a computer and various Microsoft Office (Word, Excel, and Outlook) programs
Previous experience sorting, filtering, copying and pasting data into a Microsoft Excel spreadsheet
Available to work Monday through Friday from 8:00 am to 5:00 pm EST
Previous Medicare / Medicaid experience
Ability to work effectively with a virtual team

122

Clinical Administrative Coordinator Resume Examples & Samples

The Benefit Verification Coordinator is responsible for preparing and managing paperwork and documentation for billing and collections
The Prior Authorization Coordinator is responsible for obtaining prior authorization or pre-certification of services to be rendered as required by each individual payor
The Patient Care Coordinator will provide support to the pharmacy, nursing and reimbursement departments, performing as the liaison between patient, pharmacy and nursing to effectively carry out physician's order to infusion
1+ years of experience working in an office setting using the telephone and computer as the primary instruments to perform the job duties
Comfortable working an 8 hour shift between 7:00 am and 7:00 pm, Monday through Friday with possible weekends
Prior authorization knowledge / experience
Home infusion, DME, or Pharmacy experience
Intake / Insurance experience
Medical billing or coding experience
Experience with Medicaid and / or Medicare

123

Clinical Administrative Coordinator Resume Examples & Samples

Take inbound calls from members and providers
Make outbound follow-up calls to members and providers
Gather member documents and upload them into the clinical system
Manage work queue's and assign tasks to the care coordinators
Bilingual English & Spanish
Extensive experience with Excel

124

Clinical Administrative Coordinator Resume Examples & Samples

Utilize job aids / resources and critical thinking skills at all times to perform job duties
Self-motivated / Self Starter
Punctual / Consistent Attendance is essential
4+ years of experience analyzing and solving customer problems in an office setting environment using the telephone and computer as the primary instruments to perform job duties
2+ years of professional experience in a clerical or administrative support related role
2+ years of computer experience as primary instrument to perform job duties
Intermediate proficiency with computers and Windows PC applications (this includes the ability to learn new and complex computer system applications)
Experience navigating Microsoft Office (Word, Excel, and Outlook) in a professional setting
Comfortable working Monday through Friday from 8:00 am - 5:00 pm with overtime as needed (overtime during the week usually, some weekends will be required if needed to complete the work but not often)
Medicare and / or Medicaid experience
Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand
Ability to problem solve including multiple priorities and research conflicting and/or inaccurate data
Ability to work in an ambiguous environment and collaborate across multiple areas in order to achieve a common business objective
Ability to prioritize and balance multiple demands and competing deadlines

125

Clinical Administrative Coordinator Resume Examples & Samples

Resolve customer service inquiries
Enter notifications
Complete notification wizard

126

Clinical Administrative Coordinator Resume Examples & Samples

Assembles patient’s electronic medical record accurately and completely and manages documents appropriately in CPR+
Informs Clinical and Sales Teams of referrals and updates them on the status of the case
Directs patient contact involving: schedule and verify infusion appointments/drug shipments (if applicable), respond to nursing and/or customer service issues, patient financial hardships
Maintain current and accurate documentation in CPR+/ Ask AxelaCare
Documents patient related activities/information in the patient’s electronic medical record
Check electronic discharge websites for new referrals and updated information, as required (and where applicable)
Possess the initiative to plan for and complete daily activities with minimal directions
Dependable in attendance and job performance
Ability to meet attendance, overtime, on-call, and other reliability requirements of the job
1+ year of experience in Home Care with Admissions
6+ months of insurance verification process experience
Comfortable working an 8 hour shift between 8:00 am and 6:00 pm Monday through Friday
Ability to type at least 40 wpm accurately

127

Clinical Administrative Coordinator Resume Examples & Samples

Receives Care Coordination notification cases for non-clinical assessment / intervention and provides appropriate triage
Sets up / documents / triages cases for (CCR) Clinical Coverage Review
Supervision / guidance is required for higher-level tasks
Other duties as assigned by manager and / or director
1+ years of professional experience in an office / customer service environment
Previous experience working with Microsoft Word, Microsoft Excel, and Microsoft Outlook
Available to work M-F and a couple T-S schedules starting 8:30 am - 5:00 pm

128

Clinical Administrative Coordinator Resume Examples & Samples

Drafting of NOA / NOE letters for government and Commercial Specific clients
1+ years of professional experience in an Office / Customer Service environment
1+ years of professional experience in Clerical or Administrator work
Proficiency in Microsoft Word, Microsoft Excel, and Microsoft Outlook
Ability to work an 8 hour shift between the hours of 6:00 am and 7:00 pm Monday through Saturday
2+ years of professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties, or 2+ years of Customer Service experience analyzing and solving customer problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD and CPT codes, Medicare and / or Medicaid Services, call center environment
Experience in a Medical Office Billing or Medical Assistant / Clerk
Experience with production of NOA / NOE Letters

129

Clinical Administrative Coordinator Resume Examples & Samples

2+ years of professional experience in an Office / Customer Service environment
Ability to work an 8 hour shift between the hours of 8:00 am and 7:00 pm Monday through Saturday
Experience in a Medical office billing or Medical Assistant / Clerk

130

Clinical Administrative Coordinator Resume Examples & Samples

Requesting clinical information by fax or email
Managing and prepping cases for clinical review
Notifying providers and members of case determinations
Data entry skill desired
1+ years of experience working in an Office setting using the telephone and computer as primary instruments
Experience in MS Excel with the ability to enter data within the application and taking information from spreadsheets
Experience in MS Word with the ability to create, edit, and save documents
Experience in administrative or clerical role
Healthcare industry experience
Experience with medical terminology

131

Clinical Administrative Coordinator Resume Examples & Samples

High School Diploma/GED (or higher)
1+ year of experience working within the healthcare industry
Bilingual fluency in English & Spanish

132

Clinical Administrative Coordinator Resume Examples & Samples

Monday-Friday 8am-5pm PST / CST / EST with weekends, holidays, and OT depending on business needs
Current Medicare working knowledge or experience
Vocational Technical degree in Healthcare or some College credits (or higher)
Experience working in a remote/ virtual environment

133

Clinical Administrative Coordinator Resume Examples & Samples

Previous experience working with Microsoft Word, Outlook and Excel
Professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties OR Customer Service experience analyzing and solving customer problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-9 and CPT codes, Medicare and/or Medicaid Services, call center environment

134

Associate Clinical Administrative Coordinator Resume Examples & Samples

Organizing work and develop strategies to adapt to constantly changing workload
Utilize job aids and critical thinking skills
Document 2nd MD portal to completion
Ability to take ownership of assignments
Show great accountability for work
Manage administrative tasks as assigned
Constantly meet established quality, schedule adherence and productivity standards
Previous Administrative/Office experience
Previous experience working with Microsoft Word, Excel and Outlook (ability to create, copy, edit, send and save documents)
Ability to work an 8-hour shift Monday through Friday. Schedule will be either 8:00am - 5:00pm or 8:30am-5:00pm

135

Clinical Administrative Coordinator Resume Examples & Samples

Communicates / Coordinates referrals with outside pharmacies and referral sources
Coordinates the start of care with the patient / caregiver, referral source, and other providers of care
Documents patient related activities / information in the patients electronic medical record
Send the initial referral email to sales / onsite to confirm receipt of the referral

136

Senior Clinical Administrative Coordinator Resume Examples & Samples

Work with providers and / or the clinical team to manage request for long term and respite services
1+ years of experience using the telephone and computer as primary instruments
Experience utilizing a PC computer to navigate different computer systems and experience utilizing Microsoft Excel, Microsoft Word, and Microsoft Outlook to perform job functions
Claims and / or healthcare insurance experience

137

Clinical Administrative Coordinator Resume Examples & Samples

Candidates must be able to travel on occasion into the office for meetings
Candidates must be able to work Monday through Friday from 8 AM to 5 PM
Must be able to create, edit, copy, send and save documents, correspondence and email using Microsoft Word and Outlook
Experience filtering, copying/pasting, and creating simple spreadsheets within Microsoft Excel
1+ years of customer service experience
Healthcare knowledge or experience
Telephonic customer service
Previous Secretary or BSL experience
Experience working with providers, hospitals, and healthcare facilities

138

Clinical Administrative Coordinator Resume Examples & Samples

1+ year of customer service experience analyzing and solving customer problem
Comfortable using a computer and Microsoft Office (Word, Excel, and Outlook)
Comfortable working 1:00pm - 10:00pm Monday - Friday
Prior experience in Health Care industry & HIPAA compliance workplace

139

Clinical Administrative Coordinator Resume Examples & Samples

Driving for meetings may be required
Ability to work any shift between 8:00 am and 7:00 pm Monday through Friday
Experience working with Medicare and / or Medicaid Service

140

Clinical Administrative Coordinator Resume Examples & Samples

Administrative and/or clerical experience
Experienced with MS Word and the ability to create/edit documents as well as send them in email format
Experienced with MS Excel and the ability to view/edit spreadsheets and perform data entry
Experienced with MS Outlook and the ability to send/receive emails

141

Clinical Administrative Coordinator Resume Examples & Samples

Verifies appropriate ICD - 10 and CPT coding usage
Supervision / guidance is required for higher - level tasks
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and / or Medicaid Services, Call Center environment

142

Clinical Administrative Coordinator Resume Examples & Samples

Extensive work experience with Medi-Cal community
Work with nurses and the clinical team to manage request for services from members and/or providers
2+ years of administrative or clerical experience in an office environment
Experience with Microsoft Excel, with the ability to create/edit spreadsheets, perform data entry and use sort/filter functions
Experience with Microsoft Outlook, with the ability to send/receive emails and utilize the calendar to schedule meetings
Must be able to work Monday through Friday, 8am to 5pm
FQHC knowledge or experience
Medi-Cal knowledge or experience
Ability to utilize multiple computer applications, multiple screens, and learn new applications/systems easily

143

Senior Clinical Administrative Coordinator Resume Examples & Samples

Participate in morning meetings in regards to updates on all referrals
Process new referrals that come into the queue
Finish processing any referrals from the previous day
Work with patients, insurance companies & providers over the phone to gather information and to coordinate patient care
Data Entry

144

Clinical Administrative Coordinator Resume Examples & Samples

Cancels pending / no-go referrals when appropriate
Directs patient contact involving: schedule and verify infusion appointments/drug shipments (if applicable), respond to nursing and/or customer service issues, patient financial hardships. Maintain current and accurate documentation in CPR+ / Ask AxelaCare
Professional experience in an office setting using the telephone and computer as primary instruments to perform job duties
Experience working in an Administrative or Clerical role
Must be able to create, edit, copy, send and save documents, correspondence and spreadsheets in MS Excel, MS PowerPoint, MS Word, MS Outlook
Available to work Monday - Friday 8:30am to 5:30pm and on-call on the weekends (on a rotation) with the ability to work overtime as needed
Ability to travel for two weeks during training to Lenexa, KS
Knowledge of CPR+ system
Hospital, Physician, or Medical Clinic experience

145

Clinical Administrative Coordinator Resume Examples & Samples

Management of phone calls and faxes
Intake of provider requests
Input requests into the appropriate system
Request clinical information for the clinicians to use in the review process which would include calling a facility to confirm discharge
Process notification letters
Ability to create, edit, copy, send and save documents, correspondence and spreadsheets in Microsoft Word, Microsoft Outlook, and Microsoft Excel
Computer proficiency and ability to open applications, send emails, conduct data entry and have the ability to learn new computer system applications
Ability to work an 8 hour shift between 8:00 am and 6:00 pm EST Monday through Friday and have the flexibility to work outside standard hours of operations due to changing business needs
College education

146

Clinical Administrative Coordinator Resume Examples & Samples

Welcome calls to the member to welcome them to the plan and confirm their desire to participate in the program
Review the benefits of the program
Perform a 27 question health screening – all of which will be documented within clinical platform
Must be able to work one of the following shifts – Monday-Friday 8am-5pm with possible Saturday rotation, Monday - Friday 10am-7pm with possible Saturday rotation, Monday-Friday 11am-8pm with possible Saturday rotation, and Tuesday-Saturday 9am-6pm. Shift will be assigned, all shifts with potential to be modified based on business needs
6+ months of call center experience
Excellent active listening and communication skills

147

Clinical Administrative Coordinator Resume Examples & Samples

Respond to incoming provider and member calls
Complete notification wizard along with ICD-9 and CPT coding
Initial triage of members, managing incoming calls from providers and members, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff
Organize work and develop strategies to adapt to constantly changing workload as evidenced by
Performing multiple administrative tasks while concurrently triaging phone calls and triaging customer calls
Timely response to customer and care coordination team needs
Work via an auto-dialer or manually dial members to complete the Health Risk Assessment (HRA) for Level 1 members following the New Mexico HRA as programmed into CareOne
Welcome the member to the health plan by verifying key information about the member (home address, PCP assignment, etc.) and discussing the benefits available through the plan
When possible, correct member information in CareOne, including the member’s address, PCP assignment
When appropriate, encourage members to appropriately utilize services in an effort to improve the health and well-being of all members. This might include education about the importance of using the ER only in true emergencies
Following a call anatomy, connect with the member to establish a trusting relationship and utilizing job aids and critical thinking skills, assess the barriers that are prohibiting the member from seeking the proper care and answer member’s questions about benefits
If barrier to care is provider related, the Member Advocate will assist the Member with finding a new doctor and working with provider’s office to set up new appointment
If Member is identified as having an issue meeting basic needs, the Member Advocate would help connect the member to community resources
Responsible for the resolution of escalated Member calls that are received by the Member Advocate team. This could include connecting members with community resources, assisting members to locate a specialist, and resolving other nonstandard member requests
Work offline to resolve member barriers to care requiring more research and follow-up with the member to help remove care barriers
When necessary, transfer the member to Member Services for advanced benefit questions
Document Member/Provider responses and call outcomes in CareOne as appropriate
2 + years professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties
2 + years professional experience in Clerical or Administrative work
Ability to type at least 35 WPM
Medical Terminology / Coding (ICD-9 and CPT) experience
Call Center with high volume experience
Hospital, Physician, or Medical Clinical experience
Behavioral Health, Mental Health or Addiction experience

148

Clinical Administrative Coordinator Resume Examples & Samples

Candidates must be able to work Monday through Friday from 8:00 AM to 5:00 PM
Must be able to create, edit, copy, send and save documents, correspondence and email using Microsoft Word and Microsoft Outlook
Experience filtering, copying / pasting, and creating simple spreadsheets within Microsoft Excel
Medicaid / Medicare experience

149

Clinical Administrative Coordinator Resume Examples & Samples

6+ months of working knowledge of medical terminology
Ability to use Microsoft Word (edit and save documents), Microsoft Outlook (emails, folders, calendar invites), and Microsoft Excel (update spreadsheets)
Ability to work from 7:00 am - 7:00 om Monday through Saturday

150

Clinical Administrative Coordinator Resume Examples & Samples

Resolve member service inquiries
Entering appeal notifications, Providers status of an existing notification and determining if notification is required
Assign new members monthly verifying eligibility and updating placement tab
Provide excellent service and communication to members, providers Care managers and Managers
Timely mailings of member documents, letters and plan of care
Consistently meets established productivity, schedule adherence, and quality standards while maintaining good attendance
1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
Ability to create, edit, copy, send, and save documents, correspondence and spreadsheets in Microsoft Excel, Microsoft Word, Microsoft Outlook
Ability to work 8:00 am - 4:40 pm or 5:00 pm Monday through Friday
2+ years of member service experience analyzing and solving member problems
Medical / healthcare background

151

Clinical Administrative Coordinator Resume Examples & Samples

Claims and Network Operations
Pull/gather data from relevant computer/electronic systems and software applications (e.g., imaging; electronic; email
Clarifications or corrections to data from relevant stakeholders (e.g., return missing/incorrect documents to submitters; contact
Completing Notification Wizard, along with ICD-10 and CPT Coding
Access electronic member files using policy or ID number
Waiver Service Plan processing and system entry
Member Outreach for multiple purposes such as health plan surveys, member projects or informing members of health plan initiatives
Must be able to create, copy, edit, save & send documents utilizing Word, Excel & Outlook
Experience working with Access database
Experience with Medicare and Medicaid

152

Clinical Administrative Coordinator Resume Examples & Samples

Must be able to work Monday - Friday 8:00 AM - 5:00 PM
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and / or Medicaid Services, call center environment
Must be a self - starter and able to work autonomously
Ability to work in a fast - paced, dynamic, rapidly changing environment
Ability to multi - task

153

Clinical Administrative Coordinator Resume Examples & Samples

Other duties as assigned by Supervisor / Manager
College graduate or some college preferred
Experience working with Medicare and/or Medicaid services

154

Clinical Administrative Coordinator Resume Examples & Samples

Follow department policy regarding accurate documentation of clinical data, demographic and product information, provider / facility contract status, appropriately route cases to RN for clinical review, follow departmental policy for non-clinical level notifications
1+ years of experience working in a Hospital, Physician's Office, or Medical Clinical setting
Previous experience with Medical Terminology
Previous experience working with ICD-10 and CPT codes
Ability to utilize Microsoft Word, Microsoft Excel, and Microsoft Outlook
Ability to navigate a PC and open applications
Insurance Verification and Eligibility experience
Previous DME experience (Durable Medical Equipment)
Previous Prior Authorization experience

155

Clinical Administrative Coordinator Resume Examples & Samples

Assures peer reviews are scheduled with appropriately Licensed MD based on a number of factors within expected turnaround times
Completes and submits external reviewer form including clinical summary taken from member’s record
Assign clinical cases using LINX work lists and PUMA
Research benefit details in SPDs, COCs, and with account managers
Complete facility and provider accommodation requests
Handle internal requests submitted through the TA mailbox
Process Optum referral requests
Process Psych testing requests
Generate and distribute reports to Care Advocates
Process OP authorization requests for specific BOBs and facilities
Fax Medicare letters to members at IP facilities
Mail letters for telecommuting and FCA staff as requested
Perform urgent INN bed searches for ATL Provider team
Submit requests as needed for out of network provider entries in Linx
Problem solve and fix failed member authorizations
High Diploma / GED
Candidates must be able to create, edit, copy, send and save documents, correspondence, presentations and spreadsheets in Microsoft Excel, Microsoft PowerPoint, Microsoft Word, and Microsoft Outlook
Knowledge of HIPAA compliance is preferred
Previous experience with benefits and medical terminology a plus
Prior experience in healthcare a plus

156

Clinical Administrative Coordinator Resume Examples & Samples

Enter and track data using Access and Excel, other applications
Answers phone promptly and resolves callers request or route to appropriate party
Completes provider searches for alternate levels of care using predetermined criteria, under the direction of Care Advocates. Considerable phone contact with providers
Schedules Peer-To-Peer appointments using predetermined criteria
Provides routine administrative support such as copying, faxing, preparing files, retrieving data, running reports, notifying appropriate personnel of equipment problems
Completes facility and provider accommodations under the direction of Care Advocates
Completes and submits forms for adding OON providers, under the direction of the Care Advocates
Responds to member / provider questions regarding account-specific benefits
Researches benefit details requiring review of certificates of coverage
Prepares letters for mailing, verifying accuracy
Prepare mail & UPS to go out
Create spreadsheets, word documents, other documents
Assists with technology troubleshooting
Provides back-up to other team members who are out sick or on vacation
Performs duties specific to assigned team
Familiarity with major psychiatric terminology
Bachelor’s degree (or higher)
1+ years of experience in Healthcare field
Self-starter who is able to work in fast-paced environment, able to multi-task, and work independently
Good communication skills and ability to work in a team environment
Excellent telephone skills; ability to handle calls in a courteous and helpful manner
Demonstrated strength in listening, problem solving, organizing and prioritizing

157

Clinical Administrative Coordinator Resume Examples & Samples

Submit Eligibility Requests to SURF team for routine/urgent requests
Submit facility and provider accommodation requests
Handle internal requests submitted through the TA mailbox from internal customers
Review and determine Medicare authorizations needing to be corrected or reopen
Fax Failed Medicare Authorization letters to members at IP facilities
Manage NY in-home referral program for NY Medicare BOB
Enters clinical discharge information into Clinical systems
Assign cases on the IP census
Mail authorization letters to members and providers for specific accounts
Triage BH referral requests to Clinical Staff
Add Alert notes for members in the 3 month grace period for Exchange programs
Triage uniform treatment plans to CA CAC’s
1+ years experience in an office environment and customer service experience
Clinical Terminology Knowledge
Must be able to type at least 40WPM
Must be able to open, edit, save ( MS Word, Excel) Outlook must be able to send emails and add folders

158

Associate Clinical Administrative Coordinator Resume Examples & Samples

Schedules appointments for IP with Independent Medical Examiners (IME) within 5 calendar days from the date of the assignment
Handles an approximate caseload of 80-90+ IME files
Ensures IME appointments are scheduled to occur within 21 calendar days from the date of the assignment
Facilitates and documents all actions taken on any file including, but not limited to, cancellation and rescheduling IME Appointments as requested or directed by the client, the IP or the IPs representative
Responds promptly to inquiries or requests verbally or in writing with regard to the IME file including, but not limited to, attorneys, IPs, clients or any AIMS department employee
Coordinates client approved transportation in accordance with departmental policy and procedures
Ensures appointment notification letters are generated accurately and timely in accordance with departmental policy and procedures
Ensures all medical records are complete, free from duplications, in appropriate chronological order from the date of injury to present when sent to the IME Provider
Promptly contacts IME providers when we have not received the timely IME reports in accordance with the departmental policy, standards and procedures
Ensures the quality, accuracy and completeness of the IME reports prior to processing these reports and promptly takes action to resolve any discrepancies in order to ensure timeliness
Properly identifies and submits Provider Grievances in accordance with the department policy and procedures
Properly and accurately processes all incoming mail the same business day received
Confirms and documents that all served parties received all IME notification letters and / or medical records in accordance with the departmental policy and procedures
Sends out and secures back from all Non-Contracted IME Providers a signed fee agreement prior to the IME Appointment date in accordance with departmental policies and procedures
Ensures all IME provider invoices are billed at the agreed upon and / or contracted rates and promptly resolves any discrepancies by facilitating and securing the corrected invoice
Properly processes requests / approvals for any IME fee which are in excess of any Customers agreed upon rates
Accurately processes IME internal prepayment requests
Communicates contracted IME provider updates / changes and submits IME recruitment requests per departmental policy and procedures to ensure the quality of our contracted Review Services Provider database
Facilitates IME Addendums at the direction of the Account or their representative, Case Manager or Management team
Acts as preceptor for IME Coordinators as directed by Management, if requested
Works with the AIMS team to facilitate additional medical necessity issues that may arise after the IME assignment, prior to and after the IME appointment has occurred
Ensures confidentiality and maintains accurate files and notepad entries
Adheres to cost savings measures and departmental and company-wide Quality Assurance programs
Adheres to statutory regulations, HIPAA compliance, account protocols and department policy and procedures
Performs other Review Services department duties as assigned
Maintains the integrity of RMS system at all times and adheres to all electronic paperless workflows
6+ months of experience using a computer and Microsoft Office (Word, Excel, and Outlook)
Ability to type at least 45-50 WPM
Associate's Degree (or higher)
Experience in an office setting using a Telephone and Computer to perform Job duties

159

Clinical Administrative Coordinator Resume Examples & Samples

Receive inpatient admission reports
Receive reports in regards to various other services
Review the reports
Prioritize and filter the reports
Utilize Community Care (documentation platform) to assign the reports as tasks to CHW's & RN's
Keep track of how many referrals are being tasked out
Experience with Medicaid

160

Clinical Administrative Coordinator Resume Examples & Samples

Receive and review routine pre-service authorization requests from providers submitted via a provider portal, fax, or paper submissions for chiropractic, physical therapy, occupational therapy, and / or speech therapy services
You will process these requests referencing job aides and standard policies and procedures to research relevant rules, regulations, or client-specific requirements
You will be responsible for determining whether authorizations and / or referrals are required for requested services and ensuring required documentation has been provided
You may need to access and review electronic history and notes on previous member and / or provider requests
You will be required to document applicable actions taken on a submission to ensure the request history is captured for future reference
You may be required to generate provider responses and ensure they are delivered to the mailroom for further handling
Throughout the day you will be navigating between multiple computer screens to perform these job duties
You must know how to prioritize and meet deadlines
You must be able to work with others as part of a team
You may also be responsible for transferring patient and provider demographic information and UM determinations from one application to another to ensure proper reimbursement
Associate Degree (or higher) OR a High School Diploma / GED and 2+ years of healthcare insurance experience
Comfortable working an 8-hour shift, Monday through Friday, between the hours of 6:00am to 6:00pm
Experience working with Microsoft Word, Microsoft Excel, Microsoft Outlook, and utilizing the Internet

161

Clinical Administrative Coordinator Resume Examples & Samples

Ability to work an 8-hour shift between the hours of 6:00 am and 7:00 pm Tuesday through Saturday
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-9 and CPT codes, Medicare and / or Medicaid Services, call center environment
Experience in a medical office billing or Medical Assistant / clerk
Experience with production of NOA / NOE letters

162

Clinical Administrative Coordinator Resume Examples & Samples

Ensure proper documentation procedures with regard to contracts, students� evaluations
Oversee, administer and maintain forms required for the Clinical Education year within the PA Department
Basic administrative tasks for the Clinical department Head and assist with special projects
Abilities

163

Clinical Administrative Coordinator Resume Examples & Samples

1+ years of customer service experience analyzing and solving customer problem
Comfortable working Monday - Friday from 12:00 pm - 9:00 pm with rotating Saturdays every other week from 9:00 am - 6:00 pm
Meet or exceed sales / service targets in a performance-based workplace

164

Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative tasks of minor home modification department, monitor and update Sharepoint site, schedule and attend IDT calls and document outcomes on Sharepoint site
Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and / or providers
Manage the bid process, processing incoming and outgoing faxes / bids, and prior authorizations, including intake and notifications
Handle inquiries from providers / service coordinators that may include
Bid and cost information
Authorization for completion
Manage incoming calls, managing requests for services from providers / members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the request process, processes incoming and outgoing information, and prior authorizations
Call providers in order to follow up on status of services for the members
File paperwork and faxes electronically
Must live within a 50-mile radius of Sugar Land, TX

165

HIM Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative intake of members or the admission / discharge information post notification
Intermediate skills to be able to create, edit, save and send documents utilizing Microsoft Word and Excel and to navigate a PC to open applications, send emails, and conduct data entry
Good organizational and attention to detail
Good 10 - key skills
Medical Records experience
Basic knowledge of HIPAA guidelines is important to representing the Health Information Management Department work to patients and other clinical staff. Expected to learn how to use Next Gen, and other clinical software to become effective at their job
Proficient computer skills, i.e., Windows 7 and/or Microsoft Office 2010 is a plus
At least 1 year experience with H.I.M. department operations. Successful completion of HIPAA and related legal seminars is a plus

166

Associate Clinical Administrative Coordinator Resume Examples & Samples

Work with hospitals, clinics, facilities and the clinical team to manage request for services from members and / or providers
Provide appropriate triage and care coordination notification cases for non - clinical assessment / intervention
Must be able to navigate a PC to open applications, send emails and conduct data entry

167

Clinical Administrative Coordinator Resume Examples & Samples

Must live within the Houston, TX area
2+ years of Clerical or Administrative experience
2+ years of working knowledge of Medical Terminology to communicate with members and providers
Experience working with Medicare / Medicaid

168

Clinical Administrative Coordinator Resume Examples & Samples

Associate’s Degree or higher OR a High School Diploma / GED and 2+ years of healthcare insurance experience
Comfortable working an 8-hour shift Monday-Friday between the hours of 6am-6pm
1 + years of experience in an office setting environment using the computer and phone as the primary instrument to perform job duties
Experience with behavioral health services
Proofreading skills

169

Clinical Administrative Coordinator Resume Examples & Samples

Process outpatient authorization requests for specific accounts and facilities
Manage NY in-home referral program for NY Medicare Plans
Submit Electronic Provider Updates
Resolve and analyze failed authorizations
Resolve and investigate claim inquiries from Claims Processors for payment/denial of claims
Triage uniform treatment plans to Care Advocate Centers
Experience using and navigating SharePoint
1+ years of benefit eligibility experience
1+ years of claims experience
Demonstrated ability to effectively communicate verbally and in writing
Demonstrated organizational and problem solving skills

170

Clinical Administrative Coordinator Resume Examples & Samples

Submit Eligibility Requests to SURF team for routine / urgent requests
Resolve and investigate claim inquiries from Claims Processors for payment / denial of claims
Add Alert notes for members in the 3-month grace period for Exchange programs
1+ years of experience in an office environment and customer service experience
Must be able to type at least 40 WPM
Experience using and navigating Microsoft SharePoint

171

Clinical Administrative Coordinator Resume Examples & Samples

Directs patient contact involving: schedule and verify infusion appointments / drug shipments (if applicable), respond to nursing and / or customer service issues, patient financial hardships
Maintain current and accurate documentation in CPR+ / Ask AxelaCare
Documents patient related activities / information in the patient’s electronic medical record
Send the initial referral email to sales / on site to confirm receipt of the referral
Ability to meet attendance, overtime, on - call, and other reliability requirements of the job
Comfortable working an 8 hour shift between 8:00 AM and 6:00 PM Monday through Friday
Ability to type 40+ WPM accurately

172

Clinical Administrative Coordinator Resume Examples & Samples

Process admission notifications; enter cases into Facets and ACM, fax logs to clinical team and file documents
Data entry of census updates and discharged cases; includes entry of correct dates, room type codes, discharge disposition and status; filing of documents. Performs responsibilities per the Master Schedule, including but not limited to running the Meditech census, discharges exception report, Access Center Call Log, and Transportation Log
Run admissions and discharge reports from Meditech / HCA system
Process newborn enrollment forms upon notification
Verify insurance eligibility; build case under correct member; flag cases for COB potential
Works with clinical teams to problem solve routine issues related to inpatient and skilled nursing facility cases
Maintains accuracy rating of 98% or better on all cases
Must be flexible to work any day of the week Monday - Sunday, including some holidays and must be able to work any shift between 4:00 AM - 6:00 PM
2+ years of experience working in a healthcare facility, Hospital, Physician's Office, or Managed Care setting
Previous experience working with ICD - 10 and CPT codes
Prior Authorization experience

173

Clinical Administrative Coordinator Resume Examples & Samples

Work authorization requests via RightFax
Handle pre - authorization faxes and emails for upcoming surgeries, hospital admissions, imaging and therapy, etc
Comfortable working Monday - Friday from 8:30 AM EST - 5:00 PM EST
Previous RightFax experience

174

Clinical Administrative Coordinator Resume Examples & Samples

1+ years of experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
Ability to create, edit, save, and send documents using Microsoft Word, Microsoft PowerPoint, Microsoft Access, and Microsoft Outlook
25 WPM typing / data entry skills
Advanced experience in Microsoft Excel including pivot tables
Reconciling invoices

175

Clinical Administrative Coordinator Resume Examples & Samples

Previous experience working with Microsoft Word and Microsoft Excel
Previous experience working within the Healthcare Industry
Previous experience working in a Hospital, Physician's Office, or Medical Clinical setting

176

Clinical Administrative Coordinator Resume Examples & Samples

Manage administrative intake of members and the admission / discharge information post notification
Handle resolution/inquiries from members and / or providers that may include Benefit and Eligibility information, Billing and Payment issues, Physician assignments and Authorization for treatment
Experience working within the Healthcare Industry: Hospital, Physician's Office, or Medical Clinical setting

177

Clinical Administrative Coordinator Resume Examples & Samples

Data entry of client information into designated database / Electronic Health Record (EHR) System
Processing and tracking outpatient authorization requests, and distribute the appropriate work products to clinical team for clinical review
Facsimile and photocopy duties
Efficiently answer incoming calls and provide prompt and courteous service to customers and guests. External stakeholders include Providers; Billers; CWS; Probation Officers; Attorneys, etc
Position requires ability to access the county's electronic medical record
Processing Authorizations within the established turn-around time
2+ years of Data experience in administrative or clerical support role
Ability to create, edit, save, and send documents utilizing Microsoft Word, Microsoft Excel, Adobe, and other programs
Ability to type 50 - 60 WPM, accurately
Ability to gain and maintain access to the County of San Diego's electronic health record – Cerner / CCBH
College graduate or some college
Experience working with Medicare and / or Medicaid services

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Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

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Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

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Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

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Clinical Administrative Coordinator Resume Examples & Samples

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Senior Clinical Administrative Coordinator Resume Examples & Samples

Senior Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

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Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

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Clinical Administrative Coordinator Resume Examples & Samples

Clinical Administrative Coordinator Resume Examples & Samples

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