Health Services Clinical Support Specialist (Remote eligible after training)

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

Learn more about our unique benefit offerings here.

Job Description

About the Role: You will provide daily support to Wellmark care management team members through making outbound calls to clinical staff regarding denials for services and admissions, as well as scheduling peer to peer reviews for Medical Directors. In this role, you will complete prompt and professional outbound phone and fax inquiries to obtain member discharge dates. You will also support and request clinical information as directed by the Utilization Management Nurses. On occasion, you will also provide backup for other Health Services team members as needed. Critical thinking and adaptability to change is critical in this fast-paced position.

About You: Are you excited about the opportunity to advocate for stakeholders through collaboration with multi-disciplinary teams? Are you able to manage a large variety of responsibilities while staying organized? Do you have a high attention to detail and are thorough in your work? If you are a dedicated, customer-focused health care professional motivated and inspired by the opportunity to provide administrative support to care management teams in a fast-paced environment, apply today!

• This role will require training for the first 4 weeks from our Des Moines, Iowa office. After a successful training period, you will have the option to work remote every day, or a hybrid office/home schedule based on your preference. Work hours will be from Monday through Friday from 8:30 AM - 5:00 PM Central Time.*
  
  

Qualifications

Preferred Qualifications - Great to have:

• Prior remote work experience in a fast-paced environment.
  
  

Required Qualifications - Must have:

• High School Diploma or GED.
• 1+ years of related experience in health insurance or health care industry experience with knowledge of health insurance terminology and medical coding, including the ability to translate jargon and abbreviations to medical language.
• Experience producing medical reports, correspondence, records, patient care information, statistics, medical research and/or administrative material.
• Strong written and verbal communication skills with the ability to communicate complex concepts clearly and concisely to stakeholders.
• Proficiency with Microsoft Office applications.
• Experience working in a team environment.
• Experience establishing relationships and effectively engaging with members and providers by demonstrating active listening skills through telephonic communication to obtain necessary information.
• Ability to work in a fast-paced environment where production and/or quality goals are measured.
• Demonstrated commitment to timeliness, prioritization, accuracy, and attention to detail.
  
  

Additional Information

What you will do as a Health Services Clinical Support Specialist:

• Support clinical staff by assisting them with gathering data to complete the medical necessity review process. Complete outbound inquiries via phone/fax to obtain discharge dates, and/or to request clinical information as directed by the Care Coordination Nurses.
• Create and send letters to providers and/or members to communicate information.
• Work in collaboration with other care management teams and stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member.
• Meet both quality assurance and production metrics established by Health Services.
• Perform accurate, timely documentation of pertinent information as defined in department guidelines.
• Comply with regulatory standards, accreditation standards and internal guidelines; remain current and consistent with the standards pertinent to Health Services.
• Provide backup assistance to team members as needed.
• Other duties as assigned.
  
  

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants

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