Clinical Assistant

🔥 0 minutes 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%

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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 Clinical Support by serving TennCare members across Tennessee • Maintain timely, accurate workflows supporting effective service delivery and a positive member experience • Provide phone-based provider support • Manage fax requests and support clinical operations through accurate and efficient workflow management • Screen incoming calls, faxes, and other digital requests for Utilization Management and/or Case Management • Direct calls, faxes, and digital requests to the appropriate area • Identify and refer cases appropriately 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 determinations/notifications 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 as part of the notification/prior authorization process • Rotate weekly among three shifts to meet State of Tennessee coverage requirements

🎯 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 • Digital literacy assessment required • Participation and attendance are mandatory • Flexibility due to rotating schedules and adherence to assigned schedules • Ability to work overtime as required

🏖️ Benefits

• Remote work • Structured training and preceptor period • Full training typically completed in approximately six weeks