Clinical Support Coordinator

This role handles authorization processing, member and provider inquiries, data entry, eligibility verification, and coordination with clinical teams. Provides prior authorization and utilization management support to members while reporting to the Operations Manager.

Clinical Support Coordinator


Job Summary

Provides prior authorization and utilization management support to members while reporting to the Operations Manager. This role handles authorization processing, member and provider inquiries, data entry, eligibility verification, and coordination with clinical teams.

Responsibilities

• Answer a high volume of phone inquiries.
• Load and process faxed authorizations.
• Enter authorization forms, high-risk member information, and verbal HIPAA authorization details for case creation.
• Provide support to advanced and specialist Clinical Support Coordinators.
• Assign initial EOA days or triage cases to nurses based on established workflows.
• Support Case Managers with mailings, surveys, and related administrative tasks.
• Research member eligibility, benefits, and provider networks.
• Verify member eligibility.
• Process hospital admissions.
• Send appropriate referrals to Case Management.
• Perform other duties as assigned.

Requirements

• High school diploma or equivalent.
• At least three years of relevant experience.
• Strong attendance record.
• Solid technical skills, including the ability to navigate Microsoft programs and learn internal software.
• Strong communication and teamwork skills.

Skill

• Prior authorization and utilization management support.
• Accurate data entry and documentation.
• Eligibility, benefits, and provider network research.
• Telephone communication and customer service.
• Microsoft Office and software navigation.
• Case coordination and administrative support.

Summary Qualification

• High school diploma or equivalent with at least three years of relevant experience.
• Strong technical, communication, organizational, and teamwork skills.
• Ability to manage high-volume inquiries and accurately process confidential member information.
• Reliable attendance and the ability to follow established workflows.

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.