Note: The job is a remote job and is open to candidates in USA. BlueCross BlueShield of Tennessee is hiring a Clinical Assistant to support BlueCare Plus Clinical Review Managers and serve as a key contact for providers and healthcare partners. The role handles inquiries, authorization requests, documentation, coding, and coordination of utilization and case management activities while providing compassionate, accurate member-centered support.
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 required
Skills
- High School Diploma or equivalent
- 1 year - Customer service experience is required
- 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 terminology
- Solid knowledge and understanding of provider reimbursement methodologies, ICD-10-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic
- Ability to talk and type simultaneously in a clear and concise manner while interacting with customers
- Candidates must be able to work weekly rotating shifts of 7:30–4:00 p.m., 8:00–4:30 p.m., 8:30–5:00 p.m. and 9:00-5:30 p.m. EST
- The ideal candidate has experience in a medical office setting or working with senior populations
- Success in this role requires strong communication skills, patience, attention to detail, and the ability to work independently
- Familiarity with medical terminology is preferred
Benefits
- This is a remote role within a collaborative and supportive team environment
Company Overview
Company H1B Sponsorship