Clinical Admin Coordinator

Title: Clin Admin Coord/23/MCO101

Position Title: Clinic Admin Coordinator

Maximum Pay: $22.3/hour

Work Location: Remote, must reside in TX

Work Hours: 8 hours/day with 1-hour lunch and two 15-minute breaks, 5 days per week. Includes weekends and holidays.

Dress Code: Business casual

Preferred Interview Method: Video or phone

Contract/Temporary

Job Description:

Position Overview

Adecco Healthcare & Life Sciences is hiring a Clinical Admin Coordinator. The ideal prospect supports Utilization Management (UM) processes by handling customer service and provider calls as needed. This role coordinates UM activities with WellMed Medical Directors, UM Nurses, hospitals, physicians, and various internal departments. The Coordinator provides clerical support to clinical staff during the medical necessity review process and ensures adherence to production and quality standards.

This is a fast-paced role requiring flexibility to work various shifts, including rotating weekends and holidays.

Key Responsibilities

• Perform data entry, filing, and tracking of case files, including mailing letters to patients and providers.
• Review denials to determine if they are retrospective (claims DOS) or prospective (DOS), and whether they are related to non-covered benefits (NCB) or medical necessity.
• Monitor system approval queues, print member letters, and ensure all approvals are mailed by the end of each business day.
• Prepare envelopes and letters for mailing in accordance with UM policies.
• Receive appeal requests from health plans and Quality Improvement Organizations (QIO), log requests, research, and provide necessary information.
• Collaborate with the claims department to redirect claims-related appeal requests.
• Generate reports for departmental analysis using the data entry system.
• Assist with CMS organization determination reports as required.
• Work a flexible schedule including evenings and holidays.

Required Qualifications

• Experience in healthcare-related roles.
• Telephonic and telecommute experience preferred.
• Familiarity with ICD-9 coding.
• Excellent verbal and written communication skills.
• Strong planning, organizing, conflict resolution, negotiation, and interpersonal skills.
• Ability to independently identify and resolve problems and make decisions.
• Ability to effectively interact with patients, providers, health plans, and multidisciplinary teams.
• Commitment to delivering excellent customer service internally and externally.

Certifications/Licenses

• No professional license or certification required.

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria

Pay Details: $21.00 to $22.30 per hour

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

The California Fair Chance Act

Los Angeles City Fair Chance Ordinance

Los Angeles County Fair Chance Ordinance for Employers

San Francisco Fair Chance Ordinance