UMass Med School Hiring For Clinical Support Specialist – Hybrid (North Quincy, MA) at North Quincy, MA  Full Time

Under the direction of the Manager or their designee, the Clinical Support Specialist I coordinates and performs a full range of advanced level, complex and confidential, administrative duties to assist the clinical functions of the department or program.

* Provide administrative support of the Department /Program regular activities, including but not limited all review and tracking activities.
* Respond to provider Prior Authorization (PA) inquiries on the provider help line, troubleshoot provider issues as relates to PA and billing.
* Manage electronic PA submissions, verify member information/eligibility, and enter service authorizations and other documentation in relevant information system applications in accordance with program guidelines and regulations.
* Collect and prepare PA case records for daily case assignment to OCA clinical nurse reviewers.
* Assist with administrative support functions associated with Acute Hospital Board of Hearing appeals.
* Assist in preparation of data analysis reports for the program.
* Participate in the ongoing evaluation of Department/Program activity to identify opportunities for improvement in the quality, efficiency, and effectiveness of the Department/Program towards continual process improvement.
* Administrative support work as needed, and all other duties as assigned.

REQUIRED EDUCATION
Associate degree or equivalent experience.

REQUIRED WORK EXPERIENCE
Strong interpersonal and organizational skills
Excellent problem solver and utility player
Excellent verbal and written communication skills; and engaging approach that will enrich collaboration
Ability to work independently and creatively in a rapidly changing environment
Proficient in Microsoft Office products: Word, Excel, PowerPoint, Outlook.
Ability to learn and embrace new technology to meet the needs of the program
Possess the organizational, verbal, written and interpersonal skills necessary to interact effectively with all levels of personnel and external stakeholders
Ability to prioritize, multi-task, shift priorities and execute tasks in a fast-paced environment
Ability to think critically, analyze, and determine the applicability of data, draw conclusions, and make appropriate recommendations
Ability to accept personal responsibility for the quality and timeliness of work, and for meeting expectations
Ability to seek opportunities to resolve problems, achieve goals, or otherwise to advance the program

PREFERRED WORK EXPERIENCE
Previous health care, medical administrative and/or insurance experience

PREFERRED EDUCATION
Bachelor’s degree or equivalent experience.