Clinical Intake Correspondence Specialist I, II - DOE

Work from home within WA, ID, OR, and UT

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For:

Every day, Cambia’s dedicated team of Correspondence Specialists are living our mission to make health care easier and lives better.

The Clinical Intake & Correspondence Specialist receives, researches, and takes initial action related to documentation and requests from a variety of sources related to Utilization Management (UM) Care Management (CM), and Disease Management (DM) programs.  Does not make clinical decisions, but partners with licensed health professionals on appropriate actions and responses. 

What You Bring to Cambia:

Qualifications:

• High school diploma or GED

• 3 years healthcare background, Customer Service experience or 3 years Clinical Services experience or equivalent combination or education and experience.

Skills and Attributes:

• Effective communication and writing skills.

• Strong customer service skills including listening, patience, empathy, maintaining confidentiality, and focus on meeting customer needs.

• Intermediate computer skills (e.g. Microsoft Office, Outlook, Internet search) and experience with health care systems and documentation (EMR, billing and claims).

• Strong organization, data entry, and administrative skills.

• Demonstrated knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs).  Knowledge and understanding of clinical services department programs (UM, CM, DM) and operations.

• Ability to investigate and research issues related to clinical programs and work with clinical staff to resolve.

• Ability to work independently, to prioritize work, meet deadlines and achieve operational standards. 

• Ability to work effectively in a team environment. 

What You Will Do at Cambia:

• Adheres to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work.

• Utilizes knowledge and understanding to research simple to moderately complex documentation and requests related to UM processes and requirements, and CM and DM programs from members, providers, employer groups, agents, member representatives and internal customers.

• Reviews requests for completeness of information and identifies additional information needed to initiate the request and asks for it when appropriate, but does not perform any activities that require evaluation or interpretation of clinical information.

• Validates preauthorization requirements, member benefits, eligibility, and documents information in the appropriate system. Identifies errors promptly and determines what corrective steps may be taken to resolve errors.

• Creates cases for UM, CM, DM in the Care Management System as appropriate. May administratively authorize services as directed by Clinical Services Management.

• May coordinate case information in external vendor systems for Medical Director Reviews, as necessary.

• Receives medical inpatient admission and discharge notifications, documents admission and discharge notifications as necessary for UM and CM use.

• Coordinates reviews with members, providers, clinical staff, other departments, and vendors in order to process the request and provide a complete response, as necessary.

• Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality and compliance with federal, state, BCBSA and accreditation regulations. Organizes and keeps readily accessible all reference documents, policies and procedures needed to accomplish this.

• Facilitates the member’s or provider’s understanding of the preauthorization process and of the information necessary to effectively process a preauthorization, as needed. ​

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