Job Description

About this opportunity:

Workplace Options is proud to support our sister organisation, Behavioral Health Systems (BHS), in recruiting a Clinical Support Specialist.

BHS operates one of the nation’s largest specialty preferred provider organizations (PPO), which is comprised of psychiatrists, psychologists, social workers, EAP providers as well as facility networks including hospitals, rehab/residential treatment centers, partial hospitalization programs and intensive outpatient programs. BHS fully credentials and panels their own network of providers.

Current Opportunity: Clinical Support Specialist

Location: Birmingham, Alabama

Full-time/Part-time: This is a full-time (40 hours per week) position.

Salary: $56,000 - $60,000 per annum plus competitive benefits offering

What you will do:

Under the direct supervision of the Vice President, Clinical Services and with general responsibility to the Clinical Services Division. The Clinical Support Specialist is responsible for providing essential administrative support to the Clinical Services Division, ensuring efficient patient care operations and seamless coordination across TELUS Health departments and external provider networks. This role supports critical functions including claims processing, benefits verification, and provider network research. The Clinical Support Specialist ensures accurate documentation, maintains positive working relationships with internal departments (Claims, Provider Relations, Customer Success) and external stakeholders (providers, facilities), and contributes to operational efficiency and patient satisfaction through organized, detail-oriented work.

Responsibilities:

Claims Review and Processing

• Review and verify incoming claims for accuracy and completeness using internal systems, cross-referencing both digital records and paper documentation to ensure all required information is present before processing
• Research and correct returned claims for rate discrepancies or instruction errors; document all findings in the claims management system and identify trends to prevent recurring issues
• Escalate unresolved or complex claims to assigned Care Coordinators with comprehensive claim history, detailed information, and recommended next steps; maintain ongoing communication to track resolution status

Eligibility and Benefits Verification

• Confirm patient coverage eligibility, including effective dates and termination dates, by accessing internal eligibility systems and verifying current plan status
• Verify comprehensive plan coverage details including copays, coinsurance, deductibles, out-of-pocket maximums, and benefit accumulations to ensure accurate cost-sharing information
• Document all benefit verification inquiries and findings accurately in the patient intake system for comprehensive record-keeping and auditing purposes
• Communicate verified benefit information to providers in clear, timely, and professional manner to support accurate billing and patient communication
• Follow up promptly on pending benefit verification requests and provide status updates to maintain provider satisfaction
• Identify and escalate urgent or complex benefit-related issues to supervisors for immediate attention and resolution

Provider Network Research and Development

• At the direction of Care Coordinators, research the TELUS Health provider network to identify and compile lists of provider options that align with patient-specific needs, geographic preferences, and treatment requirements
• Communicate identified network deficiencies and coverage gaps to the Provider Relations department; collaborate with network development specialists to ensure adequate and appropriate network coverage for the membership population
• Submit patient-specific provider requests initiated through retrospective claims review, patient requests, and documented network deficiencies to support continuous network improvement
• Maintain organized records of provider research activities and network development initiatives

General Administrative Duties

• Maintain accurate, organized, and compliant documentation standards for all claims, benefits verifications, and research activities
• Adhere to all TELUS Health policies, HIPAA regulations, and data security standards
• Perform other related duties as directed or deemed appropriate by supervisory staff

Qualifications:

• Bachelor's Degree in Psychology or other Mental Health related field
• 1-2 years of professional experience in healthcare, clinical, or insurance administration
• Advanced organizational and time management skills with demonstrated ability to manage complex, multi-faceted priorities independently
• Excellent written and verbal communication skills
• Proficiency with Microsoft Office Suite and healthcare-related software systems
• Demonstrated attention to detail and accuracy in data entry, analysis, and documentation
• Professional demeanor and strong interpersonal skills
• Commitment to maintaining strict patient confidentiality and HIPAA compliance

For further information about BHS please see https://behavioralhealthsystems.com/providers/

Workplace Options collects and processes personal data in accordance with applicable data protection laws. If you are a European job applicant, refer to our Privacy Notice for further details (https://www.workplaceoptions.com/privacy-notice-for-recruitment/).