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Clinical Support Specialist
Capital District Physicians Health Plan Inc | |
20 To 26 (USD) Hourly | |
paid time off | |
United States, New York, Albany | |
May 09, 2024 | |
Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience. The clinical support specialist (CSS) provides administrative support to clinical staff within Member Health. The CSS adheres to established customer service standards of accuracy, courtesy, and professionalism. This position supports timely determination turnaround times on all prior authorization requests and inpatient notifications received via telephone, fax, or mail. This position requires decision making to determine the appropriate action to take prior to logging and routing requests for authorization to the appropriate clinical reviewer. CSS reviews clinical documentation and determines at times what is being requested to allow efficient workflow. CSS reviews UM notification letters to ensure quality wording is chosen and aligns with the determination. This position must maintain a working knowledge and understanding of CDPHP benefit plans, contracts, provider networks, and Resource Coordination policies to maximize effectiveness. Answer provider and member inbound phone calls. QUALIFICATIONS:
CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay. |