CDPHP Hiring for Clinical Support Specialist at Albany Full Time

CDPHP and its family of companies are mission-driven organizations that support the health and well-being of our customers and the communities we are proud to serve. CDPHP was founded in Albany in 1984 as a physician-guided not-for-profit, and currently offers health plans in 29 counties in New York state. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Clinical Support Specialist provides administrative support to clinical staff within Medical Affairs. This representative adheres to established customer service standards of accuracy, courtesy, and professionalism. This position supports timely determination turnaround times on all prior authorization requests received via telephone, fax or mail. Responsible for logging and routing of requests for authorization to the appropriate clinical reviewer. This position must maintain a working knowledge and understanding of CDPHP benefit plans, contracts, provider networks, and Resource Coordination policies to maximize effectiveness.

QUALIFICATIONS:
High school diploma or GED required.
A minimum of two (2) years experience in a health insurance related discipline required.
Utilization management experience is preferred.
Knowledge of managed care, health plan benefits, and be able to carefully assess medical information.
Demonstrated customer service skills, and possess excellent listening, communication and interpersonal skills.
Demonstrated ability to illicit required information; interact professionally with difficult callers, provider practitioners and members with ongoing assistance and education regarding plan requirements.
Ability to apply established criteria against documentation to identify and resolve issues is required.
PC experience in a Windows environment is required.
Ability to manage multiple tasks simultaneously and in an organized manner is required.

As an Equal Opportunity / Affirmative Action Employer, CDPHP does not discriminate in employment practices on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Acuitas Health LLC, Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRX Services, LLC.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.