Clinical Service Technician

About the role

The Clinical Service Technician is responsible for receiving, registering, and forwarding clinical documentation and pre‑service authorization requests for insured members. The role ensures that all requests are processed in compliance with organizational determination regulations and benefits criteria.

Key responsibilities

• Receive requests via fax, email, regular mail, or provider portal and act as gatekeeper to classify and distribute documentation.
• Analyze medical orders to determine service type, urgency, and eligibility, checking expiration dates in coordination with group leaders.
• Perform eligibility searches and pre‑authorization requirements, validating information with providers.
• Document pre‑authorizations in insured files and enter data according to regulatory reports.
• Handle complex requests such as US services, durable medical equipment, and hospital discharge, coordinating with clinical areas.
• Monitor request turnaround times to maintain compliance percentages for authorizations.
• Process appeals in collaboration with the Grievances and Appeals Unit and support call‑center queries.

Required profile

• Associate’s degree or 60‑64 university credits in a health‑related field.
• At least one year of related experience in clinical documentation or pre‑authorization.
• Intermediate proficiency in English and Spanish (conversational, writing, comprehension).
• Knowledge of medical terminology; CPT and ICD‑10 coding preferred.

Required skills

• Medical Terminology
• CPT coding
• ICD‑10 coding