The UM Clinical Support Associate is responsible for providing support to all EXL clients by assisting UM Clinicians in obtaining the pertinent information required to perform medical reviews. This includes gathering discharge information and processing fax and letter requests. The UM Clinical Support Associate is also responsible for preparing and providing timely outbound authorization notifications to both client members and providers per plan requirements.
This full-time position requires flexibility to maintain customer satisfaction. Work hours may vary according to business demands as defined by company policies and procedures. Schedule changes may include changes in work hours and work days. Advance notification of scheduling changes will be provided in compliance with published policies.
*This position may not conduct any activities that require evaluation or interpretation of clinical information.
• Responsible for delivery of letters, both automated and manual, as well as locating and attaching medical records to appropriate charts.
• Assists the UM Clinical staff to ensure turnaround times are met for all EXL clients.
• Ensures that all required data elements are captured in the clinical information management system, while maintaining data quality and client satisfaction.
• Maintains HIPAA compliance and follows NCQA and URAC guidelines.
• Maintains quality service delivery, productivity and processes as defined by applicable policies and procedures.
• Meets all individual and team performance metrics, including but not limited to, schedule adherence and attendance.
• Assists the UM Intake team with creating cases in the clinical documentation process which includes naming and attaching faxes to cases.
• Delivers professional customer service to members, providers, and clients in accordance with all policies and procedures.
• Maintains or exceeds minimum performance standards as defined in goal documents. Basic standards include accuracy, call metrics, attendance and customer satisfaction.
• Functions as a subject matter expert and is responsible for training staff on all customer accounts, all client and internal systems.
• Performs all administrative functions as required in our contractual agreements with our clients.
• Maintains current policy and procedure information by self-study of corporate resources, attending training sessions and by seeking knowledge.
• Accountable for creating and fostering a team environment through participation in team activities and willingness to pitch in and help with special projects and to be a part of the solution.
• Demonstrated ability to type 50 words per minute, with 90% accuracy while engaged in a telephone conversation.
• Demonstrated proficiency with basic computer skills.
• Proficient in Microsoft Outlook.
• Ability to navigate multiple systems and various programs.
• Must be an effective communicator, both written and verbally – able to clearly articulate information to both providers and members.
• Demonstrated success in a call center environment to include multi-tasking as well as the ability to focus singularly on the task at hand.
• Must be flexible, willing to accept changes occurring in a dynamic environment.
• High School Diploma or GED required.
• Two years of advanced education/college or graduation from an accredited business school preferred.
Work Experience Requirements:
• Minimum two years’ experience in a health insurance environment required.
• Experience in managed healthcare environment, physician’s office, hospital business office or other healthcare industry preferred.
• Background in customer service desired.
• Knowledge of medical and/or behavioral terminology is preferred.