Job Category: Clinical - General Req #: ABACL01801 Schedule: Full Time Location: CA - Cypress
About the Position:
We are currently seeking a dynamicABA Clinical Services Assistant IIto join our Utilization Management team in Cypress, CA! The ABA Clinical Care Services Assistant II serves as central point of contact and communication for members, families, providers, insurers and members of the ABA team in the linkage of care for Applied Behavioral Analysis (ABA) services. Addresses a broad spectrum of needs and/or concerns in a professional, friendly, and efficient manner. Performs a variety of customer service and unit-operations activities to assist clinical and administrative staff to meet operational and business performance metrics.
Assist members and providers with all levels of inquiries, problem solving, insurance information and general customer service, which could include:
Customer material requests and member registration
Benefit and Eligibility information
Authorization for treatment
Billing and Payment issues
Explanation of Benefits (EOB)/Explanation of Payments (EOP)
Clinical Care Management system usage
Staff all Call Center queues and adhere to performance requirements for call center response times, abandonment rates, and other productivity, schedule, and quality standards or metrics that may be established.
Receive, respond and resolve questions about accessing ABA services.
Analyze data and identify appropriate level of care to expedite linkage to care to ABA services.
Gather required clinical and financial information care for members and enter data into clinical care management system.
Monitor the data in the clinical care management system, collaborating with provider community; escalate issues and concerns regarding care management to Senior Care Managers according to policies and procedures.
Act as a liaison with parents and the health community to ensure continuum of care and support for members.
Participates in corporate quality improvement functions.
Assists with special projects and administrative tasks as assigned.
Performs other duties as required.
Education:High School diploma or GED equivalent required
Relevant Work Experience:5 years' general working experience with 2 years' of Customer Services experience required
Knowledge, Skills, & Abilities:
Previous experience in a call center environment within the healthcare preferred
Knowledge or ability to learn state and federal laws and regulations applicable to the call center required
Strong analytical, problem solving and organizational skills required
Strong interpersonal skills needed to frequently interact with members, families, providers and insurance representatives required
General knowledge of clinical documentation, preferably electronic health records/medical records systems preferred
Ability to learn, master, and incorporate use of variety of clinical and administrative automated systems and software into daily work required
Bilingual in English and Spanish preferred
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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled
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