Position Description Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” Provides administrative support to assigned clinical team, as directed by the Team Lead and/or Manager. The Clinical Support Specialist will perform administrative tasks that support clinical processes (e.g. UM, CM, PHM), including but not limited to building medical management records (e.g. authorizations and referral management), compliance report monitoring, and completion of member/provider communications Responsibilities and Qualifications - Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes (e.g. UM, CM). - Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes (e.g. verbal notification, engagement status, discharge plan). - Supports administrative functions with community events (e.g. health fairs) - Accurately documents all interventions in the member’s medical management record in accordance with established policies and procedures. - Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership. - Adheres to all regulatory and compliance standards, including adherence to all Capital and department specific policies and procedures. - Interacts courteously and professionally with customers, including internal staff, vendor partners, providers, and members to support collaborative medical management functions. - Identifies and reports potential quality of service/care issues as established and within the guidelines of intradepartmental processes. - Promotes personal growth through participation in staff meetings, appropriate in-services, and corporate training. - Identifies opportunities and proposes alternatives for improving the Population Management functions. Skills: - Strong organizational and time management skills. - Demonstrated strong attention to detail and accuracy. - Ability to follow job responsibilities as outlined in departmental policies and procedures. - Excellent written and oral communication skills. Knowledge: - Working knowledge and operation of a personal computer, including proficiency in Microsoft Office applications. - Working knowledge of medical terminology. - Working knowledge of the health insurance industry, health plan benefits and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive). - Knowledge of regulatory and accreditation standards and requirements (e.g. NCQA, CMS). Experience: - Minimum 2 years’ experience in the medical field (e.g. medical assistant, medical secretary) or 2 years’ experience in a managed care clinical department. Education and Certifications: - High School Diploma required. - Continued higher education preferred. About Us We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

• Provides clinical review support on an as-needed basis • Responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment • Supports timely appeal submissions and inventory management while maintaining quality and compliance standards • Performs clinical reviews for medical necessity, level of care, and authorization-related denials • Reviews inpatient and outpatient medical records to support appeal submissions • Applies payer-specific guidelines and internal policies • Identifies documentation gaps and supports clear, defensible clinical narratives • Meets assigned turnaround times while maintaining quality standards • Documents review findings accurately in designated systems • Collaborates with clinical leadership as needed for escalations or complex cases

Role Description - Manage and maintain EHR systems, ensuring accuracy, organization, and usability - Build and optimize workflows, templates, and documentation structures within the EHR - Organize, tag, and structure historical medical records for easy access and analysis - Design and implement structured member journeys and touchpoints - Develop care plan templates, intake forms, and questionnaires - Translate complex healthcare data into structured, actionable workflows - Manage scheduling workflows within the EHR system - Ensure seamless coordination of appointments and member interactions - Leverage AI tools (preferably Claude) for process improvement, data structuring, and workflow efficiency - Organize and refine AI-generated clinical notes (e.g., AI scribe outputs) - Use AI to enhance operational efficiency not for creative tasks - Build standardized processes and clinical protocols - Maintain clear, structured documentation for all workflows - Continuously identify opportunities for system and process improvements - Conduct independent research to gather relevant local healthcare information - Support decision-making with accurate, data-driven insights Qualifications - 1-2 years of experience or background in clinical operations, care coordination, or healthcare administration - Experience in concierge, wellness, or high-touch healthcare environments - Familiarity with wearable health data integration - Strong communication skills. Clear, concise, and professional (client-facing readiness) - Proven experience managing EHR systems (non-billing focused) - Hands-on experience with EHR scheduling workflows - Process-driven mindset with the ability to explain workflows clearly - Experience using AI tools (Claude preferred) for structured, process-oriented tasks - Ability to organize and interpret healthcare data within systems - Experience creating templates, workflows, and structured documentation Requirements - Must be proficient in speaking and writing English very clearly - Must have relevant work experience - Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory] - Must be available for video meetings with your camera on (when needed) Technical Requirements - Device: Reliable laptop or desktop computer. - Internet: High-speed connection (minimum 15 Mbps). - Audio: Noise-canceling headset. - Video: Webcam for virtual meetings. - Workspace: Quiet, professional environment. Benefits - Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication. - Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks. - HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients. - Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention. - Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule. - Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client. - Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best. - Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

About Us Would you like to be part of a fast-growing team that believes no one should have to succumb to viral cancer? Naveris, a biotech startup based near Boston, MA, is looking for a Patient Navigation Specialist team member to help us develop our next great product for patients at risk of developing viral cancers. Our flagship test, NavDx, is a breakthrough blood-based DNA test for HPV cancers, clinically proven and already trusted by hundreds of physicians and institutions across the U.S. Opportunity As a Patient Navigation Specialist, you will coordinate the logistics and communication needed to ensure successful sample collection and testing for patients enrolled in our surveillance program. This role focuses on direct patient support, scheduling mobile blood draws, and working closely with phlebotomy vendors and internal systems. Job Responsibilities Reporting to the Sr. Patient Navigation Operations Manager, you will be supporting patients and physicians as they order the NavDx blood test. Duties include: - Serve as the main point of contact for patients requiring mobile blood draws. - Coordinate scheduling between patients and mobile phlebotomy vendors. - Monitor and update case statuses in Salesforce to reflect current progress (e.g., kit shipped, appointment scheduled, sample received). - Reach out to patients to collect missing information or reschedule as needed. Provide exceptional service and guidance to patients throughout the testing process. - Escalate clinical questions or unusual case issues to the appropriate internal contact. - Maintain detailed and timely case notes in Salesforce. - Provide backup support to the Senior Patient Navigation Specialist when needed (e.g. inbox coverage, TRF routing, or special communications). - Adhere to all internal privacy and compliance policies, including HIPAA. Requirements - High school diploma or equivalent degree is required - Proficiency with SalesForce or a similar CRM platform. - Strong written and verbal communication skills - Highly organized with excellent attention to detail and time management skills. Comfortable working in a fast-paced environment and adapting to new tools and processes. - Previous experience in a client-facing, administrative, or operations support role. - Familiarity with tools or platforms that integrate with SalesForce. Compliance Responsibilities Health Insurance Portability and Accountability Act (HIPAA) is a federal law that describes the national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. All roles at Naveris require compliance with legal and regulatory requirements of HIPAA and acceptance and adherence to all policies and standards at Naveris. Personnel acknowledges they are personally responsible for reporting any suspected violations or abuse and are required to complete HIPAA training when joining the company. Why Naveris? In addition to our great team and advanced medical technology, we offer our employees competitive compensation, work/life balance, remote work opportunities, and more! Naveris is an Equal Opportunity Employer Naveris is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We don’t just accept differences - we celebrate and support them. We do not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor. Salary Range : $25-$27/Hour