Clinical Administrative Coordinator Job Description

Clinical Administrative Coordinator Job Description

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Clinical administrative coordinator provides education to members to assist in understanding benefits, terminology, claim resolution and Explanation of Benefit interpretation.

Clinical Administrative Coordinator Duties & Responsibilities

To write an effective clinical administrative coordinator job description, begin by listing detailed duties, responsibilities and expectations. We have included clinical administrative coordinator job description templates that you can modify and use.

Sample responsibilities for this position include:

Respond to member inquiries in real time to their unique questions regarding benefits, locating providers, denials, referring to community resources
Support the believe that recovery is possible with support of strong community resources
Effectively communicate plan information to consumers, and possibly with family / supporters to make informed decision about choosing NYS Health and Recovery Plan (HARP) or Mainstream Medicaid Plan
Processes UHC letters to Commercial and Medicare members reflecting their participation in Wellness programs and upcoming coaching dates
Actively participate in departmental quality improvement goals and quality improvement other activities to promote the delivery of the highest quality services to all of the members
Work together with all staff members, other departments, to resolve issues and assist each other
Communicating both verbally and in writing to regulatory agencies other internal departments
Document all member contact in an accurate, timely, concise manner to reflect all activities
Efficiently answer incoming calls and provide prompt and courteous service to customers and guests
E-filing of all requests, treatment plans, reports

Clinical Administrative Coordinator Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Clinical Administrative Coordinator

List any licenses or certifications required by the position: MA

Education for Clinical Administrative Coordinator

Typically a job would require a certain level of education.

Employers hiring for the clinical administrative coordinator job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Health, Healthcare, Associates, Education, Business, Technical, Medical, Health Care, Sciences, Management

Skills for Clinical Administrative Coordinator

Desired skills for clinical administrative coordinator include:

Medical Terminology to communicate with members and providers
Medical terminology
Medicaid
ICD-9 and CPT codes
State and Federal regulations concerning the services and benefits
Medicare
Commercial programs
Community resources

Desired experience for clinical administrative coordinator includes:

Assists with administrative/enrollment activities for special programs disease management, complex case management, behavioral health referrals
Responsible to assist with gathering and organizing of appropriate medical records
Assist in the coordination of Discharge Planning activities on all Plan participants
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 problems
Ability to set up own computer with multiple screens
Must have internet access/wifi

Clinical Administrative Coordinator Examples

1

Clinical Administrative Coordinator Job Description

Job Description Example
Our growing company is looking for a clinical administrative coordinator. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for clinical administrative coordinator
  • Support clinical staff with QOC Inquiry correspondence within 1 business day
  • Thoroughly document activity
  • Welcome the member to the health plan by verifying key information about the member (home address, PCP assignment, ) and discussing the benefits available through the plan
  • When appropriate, encourage members to appropriately utilize services in an effort to improve the health and well-being of all members
  • Responsible for the resolution of escalated Member calls that are received by the Member Advocate team
  • Pull/gather data from relevant computer/electronic systems and software applications (e.g., imaging
  • Clarifications or corrections to data from relevant stakeholders (e.g., return missing/incorrect documents to submitters
  • Process admission notifications
  • Create a positive experience with the member
  • Assist members who are dealing with the most complex and difficult issues, including homelessness, trauma, physical health issues
Qualifications for clinical administrative coordinator
  • Ability to work in Central and/or Mountain Time
  • 2+ years experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
  • Knowledge of sampling methods and measurement techniques
  • Must be comfortable with up to 25% travel within the local area
  • Must be able to create, edit, save and send documents using Microsoft Word, Excel and Outlook
  • Capability to navigate laptop applications, create and send e-mails and formulate data entry
2

Clinical Administrative Coordinator Job Description

Job Description Example
Our growing company is looking for a clinical administrative coordinator. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for clinical administrative coordinator
  • Respond to concerns and questions from members and families
  • Handles internal and external requests submitted through the Support Service mailbox
  • Processes Intensive Outpatient Program authorizations submitted via spreadsheet for select facilities utilizing guidelines established by the ALERT Practice Management team
  • Processes Memorial Sloan - Kettering authorizations for members receiving services within the pain management clinic
  • Assist managing dedicated mailbox and process data for State specific requests and ensure that they triaged to the designated team / staff
  • Reviews and assigns clinical claims review cases to clinical staff of the CCR team using ISET and Webtrax
  • Processes ‘Benefit Exception’ requests for all accounts / books of business
  • Processes ‘Unable to Reach’ Letters for Mercer Health Advantage members
  • Processes ‘Failure to Comply’ letters to assure timely communication with facilities who have failed to contact Care Advocates regarding clinical updates
  • Handles administrative support for ‘Rhode Island Incentive Program’ including letter generation to eligible members, tracking of returned communication, database maintenance to assure accurate information is provided to Optum Bank
Qualifications for clinical administrative coordinator
  • This position requires AHCA Level II Background checks (fingerprinting) by the State of Florida for all Clinicians that have face-to-face contact with members and will require renewal every five years
  • Ability to bend or crouch to reach low items
  • 2+ experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
  • Flexibility to work outside standard hours of operations due to changing business needs (potential for mandatory overtime after hours and weekends)
  • 1+ year of telephonic or face to face customer service experience
  • Previous experience working with Microsoft Office Word, Excel and Outlook (must be able to create, edit, save and send documents utilizing Microsoft)
3

Clinical Administrative Coordinator Job Description

Job Description Example
Our innovative and growing company is looking for a clinical administrative coordinator. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for clinical administrative coordinator
  • Provides backup to the Teleform verification of Wellness Assessments and Outpatient Treatment Reports including researching issues that impact the ability to process ALERT Wellness Assessment and OTRs, eligibility, provider status, accuracy of provider information
  • Data entry of census updates and discharged cases
  • Data entry of client information into designated database / Electronic Health Record (EHR) System Processing and tracking inpatient and outpatient authorization requests within designated turnaround times Distribution of appropriate work products to clinical teams for clinical review
  • Cross train in all clinical support processes E-filing of all incoming authorization requests 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, and photocopy machine
  • Write or revise current processes
  • Manage the requests for NOA / NOE Letters
  • Prepare letters for audit review
  • Identify gaps in compliance with letters and ensure letter corrections are made within regulatory timeframes
  • Act as SME for letters
Qualifications for clinical administrative coordinator
  • 1+ year of professional experience in an office/customer service environment
  • Flexibility to work outside standard hours of operations due to changing business needs (A full-time schedule between business hours
  • Ability to keep all information confidential per HIPPA requirements
  • 2+ years of experience in a healthcare facility, medical office, hospital or managed care setting
  • Must be able to navigate a Windows PC and the ability to use/ learn new applications easily
  • Intermediate proficiency with MS Word with the ability to create/ edit documents, import files, format
4

Clinical Administrative Coordinator Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of clinical administrative coordinator. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for clinical administrative coordinator
  • Tuesday - Saturday work schedule
  • Inbound / Outbound call center
  • Complete / Enter program referrals
  • Engagement with members and providers
  • Assist RN & SW with various assignments
  • Manages incoming communication calls / faxes / emails / tasking group – members / providers
  • Handle pre-authorization calls for upcoming surgeries, hospital admissions, imaging and therapy
  • Monitor timely receipt, accuracy and compliance of State assessments
  • Maintain 100% adherence to State contract, CMS requirements, and UnitedHealthcare Community Plan Performance and Quality metrics around Star+Plus Waiver Conversion Goals
  • Demonstrate compliance in the urgency of all Star + Plus Waiver State & internal deadlines
Qualifications for clinical administrative coordinator
  • Ability to travel up to 5% of the time for training events
  • Intermediate proficiency with MS Excel with the ability to create/ edit spreadsheets, create formulas, use sort/filter functions
  • Intermediate proficiency with MS Outlook with the ability to send/ receive emails, use the calendar for scheduling, assign/maintain tasks
  • Medical or Healthcare industry experience
  • 1+ year of experience in clerical or administrative role
  • Experience in providing patient counseling and instruction
5

Clinical Administrative Coordinator Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of clinical administrative coordinator. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for clinical administrative coordinator
  • Assists with the facilitation around Medicare covered services and / or community based services
  • Assist the Medical Management team with communicating transition of care services for members
  • Generate and create referrals to health plan programs and outpatient services
  • Access multiple hospital-based electronic systems for the purpose of ensuring accurate patient admission information, , diagnosis, patient demographics and census reconciliation
  • Data entry of patient level of care and other case related information, at the direction of the clinical team
  • Trained to provide back - up support to Clinical Administrative Coordinator Sr
  • Mailing of customer packet (s)
  • Assist in event set up, administration, and deconstruction
  • Coordinate student scheduling for events
  • Responsible for lab supply and ordering
Qualifications for clinical administrative coordinator
  • Must be able to work 8 hour shifts M - F between 9 AM - 7 PM
  • Ability to work under pressure to meet tight deadlines and adapt to changing priorities
  • Experience in planning, coordinating, and directing the work of subordinate staff
  • Experienced with MS Word and the ability to create/edit documents send them in email format
  • Excellent interpersonal, written and verbal communication skills (using grammatically correct written English and accurate typing) to interact with a variety of personalities at all levels of the organization, exercising tact, mature judgment, diplomacy, and flexibility to promote positive working relationships and job effectiveness
  • Proven ability to act on initiative and exercise independent judgment in executing a wide variety of functions and maintaining absolute reliability in handling confidential and sensitive matters

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