Clinical Assistant

Job Title

Remote- 1st preference will be local to TN to get shortlisted and get interviews and 2nd preference will be from BCBST approved states which are below.

Qualifications

All applicants will be advised that Client, as a federal contractor, may be required to implement a COVID-19 vaccine mandate. Job Qualifications Education o High School Diploma or equivalent Experience o 1 year - Customer service experience is required Skills/Certifications o Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) o Proficient oral and written communication skills o Proficient interpersonal and organizational skills o Exceptional time management skills o Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment o Independent, sound decision-making and problem-solving skills o If current employee with the company, must meet minimum performance expectations o Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health. o Knowledge and understanding of Medical terminology o Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic o Ability to talk and type simultaneously in a clear and concise manner while interacting with customers

Responsibilities

Job Profile Summary Supports customer service activities and initiatives for a number of products or clients including but not limited to the Case Management and Utilization Management departments. Job Description Job Responsibilities o Screen incoming calls and/or faxes or other digital format for UM and/or CM and direct calls/faxes/other digital requests to the appropriate area. Identify and refer cases appropriately to the Case Management and/or Transition of Care department. o Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned. o Load complete organization determination/notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines. o Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, giving direction as necessary. o Search for and key appropriate diagnosis and/or procedure code as part of the notification /prior authorization process. o Must be able to pass required testing. o Participation and attendance are mandatory. o This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules. o Work overtime as required

Comments/Special Instructions

Appeals and/or Grievance Preferred. Experience with Dual - SNP plans preferred.