Strategic Staffing Solutions
Title: Clinical Support Representative
Location: Berlin, VT (or Remote)
Duration: 3+ Months with opportunity to extend
Role Type: W2 Contract Engagement
Pay Rate: 20-23
*Candidate is required to supply their own laptop or home computer.
Engagement Description
The Clinical Support Representative’s primary responsibility is to facilitate and coordinate preadmission/admission reviews, prior approvals and referral requests through the medical review cycle in compliance with Rule 10, DOL, NCQA, and URAC (Utilization Review Accreditation Commission) timeliness requirements. This includes generating and performing quality assurance of correspondence, entering authorizations to ensure appropriate claims processing, and maintaining electronic medical records. The Clinical Support Representative is also responsible for answering department phone calls and evaluating issues and questions from internal and external customers. The Representative provides exceptional customer service when interacting with all internal and external customers and always maintains the highest level of confidentiality.
Top Required Skills/Experience
- Understanding of plan benefits and products
- Understanding of claims adjudication and data systems
- Understanding of medical terminology and medical coding, to include ICD-9, HCPCS, and CPT4
- Understanding of URAC, NCQA, Rule 10, DOL, and other regulatory standards pertaining to Case/Care Management
- Computer Skills– Competent in use of MS Office Applications (specifically Outlook, Word and Excel), AS400 legacy, MHS, Lotus Notes, Customer Focus, OnBase, The Knowledge Center, FEP Direct, web browsing, Acuity and phone system
- Strong written and oral communications skills, with advanced listening skills to be able to identify provider and subscriber concerns
Required Skills/Experience
- 1-3 years experience in the healthcare industry, preferably health insurance
- Strong interpersonal skills, including the ability to effectively maintain a consistently pleasant, courteous, and positive manner in responding to all subscriber and provider telephone inquiries, including those from angry or difficult customers
- Strong organizational skills, including the ability to work independently, demonstrate attention to detail with accuracy, utilize resources, and manage/prioritize increasing volume within quality standards
- Strong analytical skills, including research and analysis
Education/Certifications
- High School Diploma
- Associates Degree
*Beware of scams. S3 never asks for money during its onboarding process
Job ID: JOB-241775
Publish Date: 30 May 2025