Clinical Assistant
The BlueCare Utilization Management is excited to expand our team with a Clinical Assistant. In this position, you will be responsible for handling incoming calls related to prior authorizations, entering demographic information in coordination with the clinical team, and addressing Customer Service inquiries, among other essential duties. If you're detail-oriented, thrive in a fast-paced setting, and enjoy working alongside a dedicated clinical team, we'd love to hear from you! You will be a great match for this role if you have :
- 1+ years of Customer Service and Claims experience
- Non-Clinical Utilization Management experience
- Facets, Care Advance experience and Agent Workspace experience
Job Responsibilities :
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.Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned.Load complete organization determination / notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines.Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, requesting additional or clarifying information and giving direction as necessary.Search for and key appropriate diagnosis and / or procedure code as part of the notification / prior authorization process.This job requires digital literacy assessment.Participation and attendance are mandatory.This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.Work overtime as requiredJob Qualifications :
Education : High School Diploma or equivalentExperience : 1 year - Customer service experience is requiredSkills / Certifications : Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint). Proficient oral and written communication skills. Proficient interpersonal and organizational skills. Exceptional time management skills. Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment. Independent, sound decision-making and problem-solving skills. If current employee with the company, must meet minimum performance expectations. Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health.Knowledge and understanding of Medical terminologySolid knowledge and understanding of provider reimbursement methodologies, ICD-10-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding ClinicAbility to talk and type simultaneously in a clear and concise manner while interacting with customersNumber of Openings Available : 1
Worker Type : Employee
Company : VSHP Volunteer State Health Plan, Inc
Applying for this job indicates your acknowledgement and understanding of the following statements :
BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.