Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of Correspondence Specialists are living our mission to make health care easier and lives better.
The Clinical Intake & Correspondence Specialist receives, researches, and takes initial action related to documentation and requests from a variety of sources related to Utilization Management (UM) Care Management (CM), and Disease Management (DM) programs. Does not make clinical decisions, but partners with licensed health professionals on appropriate actions and responses.
What You Bring to Cambia:
Qualifications:
High school diploma or GED
3 years healthcare background, Customer Service experience or 3 years Clinical Services experience or equivalent combination or education and experience.
Skills and Attributes:
Effective communication and writing skills.
Strong customer service skills including listening, patience, empathy, maintaining confidentiality, and focus on meeting customer needs.
Intermediate computer skills (e.g. Microsoft Office, Outlook, Internet search) and experience with health care systems and documentation (EMR, billing and claims).
Strong organization, data entry, and administrative skills.
Demonstrated knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs). Knowledge and understanding of clinical services department programs (UM, CM, DM) and operations.
Ability to investigate and research issues related to clinical programs and work with clinical staff to resolve.
Ability to work independently, to prioritize work, meet deadlines and achieve operational standards.
Ability to work effectively in a team environment.
What You Will Do at Cambia:
Adheres to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work.
Utilizes knowledge and understanding to research simple to moderately complex documentation and requests related to UM processes and requirements, and CM and DM programs from members, providers, employer groups, agents, member representatives and internal customers.
Reviews requests for completeness of information and identifies additional information needed to initiate the request and asks for it when appropriate, but does not perform any activities that require evaluation or interpretation of clinical information.
Validates preauthorization requirements, member benefits, eligibility, and documents information in the appropriate system. Identifies errors promptly and determines what corrective steps may be taken to resolve errors.
Creates cases for UM, CM, DM in the Care Management System as appropriate. May administratively authorize services as directed by Clinical Services Management.
May coordinate case information in external vendor systems for Medical Director Reviews, as necessary.
Receives medical inpatient admission and discharge notifications, documents admission and discharge notifications as necessary for UM and CM use.
Coordinates reviews with members, providers, clinical staff, other departments, and vendors in order to process the request and provide a complete response, as necessary.
Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality and compliance with federal, state, BCBSA and accreditation regulations. Organizes and keeps readily accessible all reference documents, policies and procedures needed to accomplish this.
Facilitates the member's or provider's understanding of the preauthorization process and of the information necessary to effectively process a preauthorization, as needed.
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The starting hourly range for this role is $21.20 - $30/hour, depending on candidate's geographic location and experience. The full range for this role is $21.20 - $37.50 an hour.
The annual incentive payment target for this position is 5%.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
Work alongside diverse teams building cutting-edge solutions to transform health care.
Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
Grow your career with a company committed to helping you succeed.
Give back to your community by participating in Cambia-supported outreach programs.
Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
