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Clinical Support Specialist II (Social Work)

Company: Aerotek
Location: Wixom
Posted on: May 7, 2021

Job Description:

**Our client is looking to add a Clinical Support Specialist II to their team. From April 2021 - Dec 2021 it is going to be a work from home opportunity. The company as a return to work plan that will have employees working in the office again as of Jan 2022. This position is the front line interface to members and providers who seek information about behavioral health benefits. Assist callers by providing benefit and eligibility information and referrals to network providers.**

Assist with Clinical Department operations Conduct referrals, follow-up protocols, investigation of complex member/provider issues not requiring a medical necessity determination, claims issues and managing data to ensure patient and provider continuity of services. Provide guidance and handle complicated inquiries related to case initiation to internal and external customers. Educate providers/subscribers in the certification process and help to reconcile inconsistencies and procedural difficulties.

Duties and Responsibilities

1. Interface with medical carriers, claims payers, other. Initiates and maintains positive and productive relationships with external and internal customers. Handles difficult customer service problems and expedites resolution.

2. Assist department/unit with call management. Interface with external and internal customers to ensure optimal efficiency of accessing behavioral health services. Provide education to providers and members on all aspects of care management services. Perform review of service request for completeness of information.

Verifies member benefits and eligibility through health plan computer access, phone, and e-mail. Educates callers about services available to them and their mental health benefits. Obtains urgent, routine with assistance appointments within established time frame guidelines. Checks voice mail and return calls within 1 business day.

Checks e-mail to stay informed of procedures and communicate with team members.

Works with health plan, County entities, community agencies and providers to effectively coordinates member care.

3. Verify benefits against contract requirements prior to case initiation. Refer complicated inquires to Care Managers. Complete transactions/authorizations. Prepare account specific cases for Care Manager follow-up. Process account specific outpatient authorizations. Assist with triage assessment and referral process.

4. Perform follow-up services for cases that may include CDR/EAP involvement & associated tasks, ambulatory follow-up procedures, depression management, medical/behavioral coordination and intensive care management protocols. Screen psychological testing requests for Care Manager follow up. Assist with specialty/distance waivers by completing rate negotiations and appropriate paperwork. Assist Care Managers in gathering data and making appropriate referrals to providers.

5. Search for specialty providers or referrals in areas with difficult access and may respond to complicated inquiries. May participate in the investigation and resolution of claims and/or case issues. Oversee and support work process for clerical support staff. Collect and transfer non-clinical data. Acquire structured clinical data. Perform activities that do not require evaluation or interpretation of clinical data. Obtain and enter discharge information. Participate in periodic systems testing.

6. Administer, track and record complaints, appeals, out of network authorizations including research and referrals in difficult access areas. Process appeal/denial issues. Investigate and resolve customer issues/complaints. Prepare and send out appeal letters per appeal policies.

7. Perform responsibilities in accordance with contract standards. Provide training, as needed based on department needs. Assist service center with compliance of regulatory standards.

8. Initiate and maintain all databases and records used by the Department. Enter data, update and/or correct information, run queries and reports. Prepare symposium reports.

**Skills:**

Social work, Behavioral health, Clinical assessment

**Requirement:**

+ Bachelor's in Social Work (preferred) / will also consider a Bachelor's in Psychology

#LIJOBS

**About Aerotek:**

We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Keywords: Aerotek, Detroit , Clinical Support Specialist II (Social Work), Healthcare , Wixom, Michigan

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