Clinical Operations Support Specialist

:

Clinical Operations Support Specialist

- (2400026)

The Clinical Operations Support Specialist position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, OH Medical Mutual office.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Under general supervision, receives and reviews incoming clinical and related documentation from various sources and prepares and assigns clinical files for nurse review. Investigates and processes claims and/or issues and performs administrative functions in support of utilization management and effective daily operations of the department.

Responsibilities

• Receives correspondence from various sources such as providers, members, and internal departments, and determines appropriate recipient, action and priority following departmental guidelines. Prepares and assigns clinical files, ascertains information is correct, and directs to the appropriate nurse reviewer or area.
• Investigates, processes, and responds to routine to moderately complex claim issues/problems in support of utilization management programs. Reviews and completes pended (exception/flagged) claims or triages as needed.
• Processes responses to phone/ fax inquiries from providers, members, and internal departments regarding claim status information. Manages departmental email for pended claim related issues by resolving within scope of authority or tiering to appropriate nurse reviewer.
• Performs administrative support functions including creating and maintaining files, data entry, indexes documents, receives, distributes and purges mail, generates correspondence/reports, etc.
• Performs other duties as assigned.

Qualifications

Education and Experience

• Bachelors' Degree in Business Administration or related field preferred, but will consider collective experience, training and education.
• 3 years clinical operations support experience in health insurance or equivalent office experience supporting Nurses and Physicians in a healthcare environment.

Technical Skills and Knowledge

• Knowledge of medical terminology, health insurance claims processing, and utilization review processes.
• Knowledge of HIPAA (Health Insurance Portability and Accountability Act) and Protected Health Information (PHI) regulations.
• Intermediate Microsoft Office (Word, Excel, Outlook) skills. Proficiency with document management systems (e.g. OnBase).
• Solid data entry skills.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• Top Workplace in Northeast Ohio. Year after year we've received this recognition!
• On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
• On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
• Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member
• Business Casual attire

Excellent Benefits and Compensation:

• Competitive compensation plans
• Employee bonus program
• 401(k) with company match and an additional company contribution
• Excellent medical, dental, vision, and disability insurance

An Investment in You:

• Career development programs and classes
• Mentoring and coaching to help you advance
• Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Primary Location US-OH-Brooklyn Work Locations Brooklyn 100 American Road Brooklyn 44144 Job 7 - General Staff Organization Clinical Operations Schedule Regular Shift Standard Employee Status Individual Contributor Job Type Full-time Job Level Day Job Job Posting Jan 11, 2024, 2:10:14 PM