Salary Range: $19.88 - $28.83

Job Overview

The Clinical Support Associate (CSA) is responsible for providing coordination support for the clinical teams, supporting the daily operational functions, facilitating timely work processes, and performing clerical activities for their assigned unit(s). The selected candidate to fill this CSA position must have strong and clear written and verbal communication skills as the positions responsibilities will also include:

• Accurate and timely data entry and data collection.
• Interact with other CenCal Health employees and providers.
• Make outbound calls to providers, members, and CenCal Health staff regarding operational processes.
• Process authorization and referral requests.

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This is a full-time hybrid position. If the selected candidate is a Santa Barbara area resident, then they will need to go into our main office once a week for several hours. This will be scheduled by the units manager.

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Regular attendance is essential to perform this job.

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Please Note: Clinical Support Associates (CSA) are assigned to one of several Health Services clinical units. These units include Utilization Management (UM), Case Management (CM), Enhanced Care Management (ECM)/Community Supports (CS) (In Lieu of Service), Care Coordination (CC), Disease Management (DM), Behavioral Health (BH) and Pediatric-Whole Child Model program (Pediatric). The CSA reports to the unit manager or their designee.

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Duties and Responsibilities

This position receives day-to-day supervision by the unit manager or their designee and include, but is not limited to, the following tasks for their specified unit:

General CSA Duties and Responsibilities:

• Timely answering of inbound calls in the Health Services phone queues
• Make outbound calls to providers, members, and CenCal Health staff regarding operational processes
• Timely communication of conflicts or difficulties with members or providers to the immediate supervisor
• Maintain confidentiality and privacy of member information in adherence to HIPAA and Confidentiality laws and regulations
• Adhere to CenCal Healths mission, protocols, policies and procedures and meet required performance standards
• Timely attendance of Company-wide and department meetings and trainings and, as appropriate, actively participate
• Respond to emails, telephone calls, and other modes of communication promptly, professionally and courteously
• Interact with CenCal Health employees, members, and providers professionally
• Other duties and projects as assigned

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When assigned to Utilization Management:

• Answer inbound calls from unit phone queue and make outbound calls to providers and members regarding authorization request status
• Accurately enter authorization requests and submitted documents into the authorization system
• Obtain all necessary documentation required to process referrals and requests for covered services
• Respond to inquiries regarding the authorization processes and request statuses from providers, members and staff from other departments
• Act as a liaison between clinical reviewers and providers/members
• Accurately enter billing and diagnosis codes, category and type of service, amount, frequency, and/or volume of requested or approved services and procedures
• Process authorization requests within established timeliness standards
• Track and monitor timeliness of service authorization and referral requests
• Accurately prepare, edit and finalize written determination notices to providers and members
• Prepare timely and accurately formatted notices and retain/store documents related to authorization request and determination notices
• Verify eligibility and/or other payor source
• Collaborate and communicate with other Health Plan departments such as, but not limited to, Member Services, Providers Services and Claims
• Inform members and providers of the authorization and appeal processes
• Adhere to authorization timelines of Federal and State agencies that govern health plan operations
• As directed, process long term care recertification
• As directed, process inpatient authorization request
• Process limited authorization request according to written guidelines
• Other duties as assigned

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Skills/Knowledge/Abilities

Required:

• Ability to work independently and follow directions with minimal supervision and as an active participant of an interdisciplinary team
• Ability to utilize constructive feedback as a learning and growth opportunity
• Demonstrate excellent organizational and multi-tasking skills
• Understand basic medical terminology, billing (CPT) and diagnoses (ICD-10) coding
• Maintain member confidentiality and HIPAA compliance
• Must be detail-oriented and maintain clear and accurate records
• Complete assigned duties while adhering to regulatory timelines
• Must be able to type at a minimum of 35 wpm
• Work effectively with people with varying backgrounds and educational levels
• Prepare grammatically correct, clear and concise correspondence

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Preferred:

• Basic knowledge of Medi-Cal and its covered services
• Knowledge of health-related community-based organizations, health care delivery systems, and resources for the low income and elderly population
• As designated, bilingual in Spanish (not required for Utilization Management positions)

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Education and Experience

Required:

• High school diploma or GED
• Associates degree in business, health science, healthcare, health management or related field OR three (3) years of experience as a Certified Medical Assistant, Certified Nursing Assistant or Licensed Vocational/Practical Nurse may substitute for an Associate Degree
• Twelve (12) months of full-time, or its equivalent, experience in a medical office, health plan, managed care organization, hospital (ED or inpatient), skilled nursing facility, clinic or other healthcare setting working directly with patients, members, providers and/or other clinicians
  • Successful completion of one of the following accredited education programs: Medical Assistant or Medical Office Professional. Successful completion can substitute for six (6) months of work experience

Preferred:

• Bachelors degree in one of the above fields
• Two (2) years of full-time, or its equivalent, of clinical experience in an outpatient or ED clinic, health plan, managed care or medical office setting

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Additional Information:

Schedule:

• Full-time Hybrid position
• Monday Friday

Benefits:

• Pension Plan
• Professional Development and Wellness Benefits
• Alternative Transportation Incentives
• Comprehensive medical, dental, vision & life insurance
• Paid Time Off
• Ten (10) paid holidays per year