What are the responsibilities and job description for the Clinical Support Coordinator position at Squirrel Hill Health Center?
Squirrel Hill Health Center (SHHC), is a Federally Qualified Health Center (FQHC), seeking a dedicated Clinical Support Coordinator to join our team. The ideal candidate will ensure that healthcare services, medications, or treatments are approved by insurance providers before they are administered. This role involves acting as a liaison between patients, healthcare providers, and insurance companies to streamline the authorization process. The Clinical Support Coordinator will assist SHHC Providers in managing and maintaining electronic or paper-based forms to ensure accurate and complete data collection and documentation. This position requires prompt, courteous, professional, and accurate interactions with SHHC patients to ensure the smooth flow of both people and information through the SHHC system. The role involves working in-office, remotely (in a private, HIPAA-compliant workspace), and independently, with the ability to travel to other locations for coverage as directed.
Responsibilities:
- Authorization Management:
- Submit and follow up on prior authorization requests for medications, procedures, or treatments.
- Communicate with insurance companies to ensure timely processing of authorizations.
- Verify patients' insurance coverage and benefits for specific services.
- Coordination:
- Collaborate with healthcare providers to gather necessary documentation and clinical information.
- Act as a liaison between patients, healthcare providers, and insurance companies.
- Notify providers and patients of approval or denial statuses, including next steps for appeals if necessary.
- Documentation:
- Accurately document all communication, actions, and decisions related to prior authorizations and Provider forms distribution.
- Maintain compliance with HIPAA and other healthcare regulations.
- Problem Resolution:
- Resolve authorization delays or denials by communicating with insurance representatives.
- Analyze denial reasons and recommend appropriate follow-up actions.
- Customer Service:
- Provide clear and empathetic communication to patients regarding insurance requirements.
- Educate providers and staff about payer requirements and updates.
- Act as a liaison between patients, physicians/NPs/PAs, and other entities regarding Clinical Operations and patient needs.
- Obtain release of information to seek necessary records and ensure proper review and follow-up with physicians/NPs/PAs.
- Other Duties:
- Ensure forms comply with company, industry, or regulatory standards.
- Accurately, promptly, and consistently document all patient interactions in the Electronic Health Record.
- Maintain confidentiality and compliance with HIPAA.
- Refer patients to the Care Navigation Team for necessary social services.
- Coordinate clinics and other offsite prevention services as directed by SHHC Management.
- Perform other duties as directed.
Qualifications:
- High school diploma or GED required; associate’s degree or healthcare-related certification preferred.
- 1-3 years of experience in a healthcare setting, insurance verification, or prior authorization.
- Knowledge of medical terminology, ICD-10, and CPT coding.
- Proficiency in using healthcare software systems and ability to learn new systems.
- Strong computer skills, including proficiency in EHR, Microsoft Word, Teams, Outlook, and Excel.
- Ability to assess, understand, and react effectively to the unique needs of various patient populations served.
- Excellent critical thinking, organizational, interpersonal, and communication skills.
- Attention to detail for design accuracy and compliance.
- Professional and effective communication with a wide range of clients in person and by telephone or Portal.
- Ability to manage work efficiently and consistently.
- Fluency in a second language is preferred.
- Must be able to work in any SHHC location onsite or remotely as needed.
- Must accommodate occasional schedule changes to provide patient care.
- CPR certification preferred but not necessary.
- Commitment to serving populations consistent with SHHC’s mission.
- All CDC recommended vaccinations, including annual Covid and Flu, required.
SHHC is an Equal Opportunity Employer. SHHC does not and will not discriminate in employment and personnel practices to include hiring, transferring and promotion practices on the basis of race, color, sex, sexual orientation, gender identity, age, handicap, disability, religion, religious creed, ancestry, national origin or any other basis prohibited by applicable law.
