Clinical Assistant

🔥 2 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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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

• 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.

🎯 Requirements

• 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 • 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

🏖️ Benefits

• Health insurance