Northwell Health Lead, Care Support Specialist in Greenvale, New York

Req Number 001ELR

Job Category General Clerical/Secretarial

Job Description

Leads and guides Care Support Specialists in the performance of duties. Reviews and facilitates incoming precertification requests for initiation of authorization approval. Handles administrative support functions related to all departments under the division of Medical Management. Collaborates with nursing staff, non-clinical staff, and other professional staff to assist with process flow. Works in collaboration with other departments throughout the organization to ensure adherence to policies and procedures.

1. Leads and guides Care Support Specialists in the performance of duties:

· - Participates in orientation, training and in-service activities for Care Support Specialists.

· - Assists in scheduling, prioritizing and assigning work based on workflow fluctuations.

· - Serves as a mentor for difficult orcomplex precertification requests .

· - Addresses issues with Supervisor.

2. Reviews incoming precertification requests for authorization retrieval:

· - Answers incoming calls from requesting physician office/provider.

· - Obtains patient identification information, i.e. name, date of birth, etc.

· - Obtains service request details, i.e. date of service, facility, requesting provider, etc.

· - Obtains clinical service information, i.e. diagnosis/procedure code, etc. for clinical team.

  1. Facilitates precertification process to aid in authorization initiation:

· - Utilizes rules engine to identify precertification requirements.

· - Supplies precertification status to requesting provider via phone.

· - Generates precertification status letter; fax to requesting provider and mail to patient.

· - Documents case information precisely and completely in appropriate system.

· - Acts as liaison between requesting provider and nurse reviewer.

· - Refers pending cases to Utilization Review Nurses for additional follow up.

· - Works with Utilization Review Nurses to aid in timely completeness of precertification.

· - Performs clerical duties as assigned.

  1. Performs administrative support functions:

· - Tracks and maintains all clinical cases.

· - Manages case data and reports.

· - Files and sorts clinical cases in designated location.

· - Assists with faxes and letters.

· - Acts as a back-up for the appeals and grievance functions.

  1. Performs related duties as required.

*ADA Essential Functions

Qualifications

· High School Diploma or equivalent, required. Associate’s Degree in Healthcare Administration or related field, preferred.

· Minimum of four (4) years clerical administrative experience in physician office, hospital or healthcare insurance setting, required. Prior medical healthcare utilization review experience, required.

· Knowledge of ICD9/10 and CPT coding, required.

· Excellent organizational skills, required.

Excellent customer service skills, required. Ability to communicate and interact effectively with patients, families, and healthcare providers, required.