Clinical Assistant

🔥 1 minute ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Support BlueCare Plus Clinical Review Managers at BCBST • Serve as a key point of contact for providers and healthcare partners • Answer provider questions • Load authorization faxes • Enter authorization requests received by phone • Direct providers through the peer-to-peer review process • Provide timely, accurate support through phone interactions and administrative coordination • Deliver compassionate, member-centered support and respond to inquiries with empathy • Screen incoming calls, faxes, and other digital requests for Utilization Management and/or Case Management • Direct requests to the appropriate area and refer cases to Case Management and/or Transition of Care • Receive, investigate, and resolve customer inquiries and claims • Maintain departmental goals and perform assigned projects, reviews, and reports • Load complete organization determination/notification for services according to internal policy • Document and enter data into the appropriate system using departmental guidelines • Interact with members, hospital staff, and provider staff regarding Utilization Management decisions and organization determination status • Request additional or clarifying information and provide direction as necessary • Search for and enter appropriate diagnosis and/or procedure codes during notification/prior authorization processes • Work overtime as required

🎯 Requirements

• High School Diploma or equivalent • 1 year of 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 • 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 • Ability 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 • Digital literacy assessment required • Mandatory participation and attendance • Flexibility and adherence to assigned schedules • If current employee with the company, must meet minimum performance expectations

🏖️ Benefits

• Remote work within a collaborative and supportive team environment • Overtime may be required based on business needs