Clinical Assistant

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Assist BlueCare Plus Clinical Review Managers at BCBST

• Act as a primary contact for providers and healthcare partners

• Address inquiries from providers

• Manage authorization faxes

• Process authorization requests received via phone

• Guide providers through the peer-to-peer review process

• Provide prompt and accurate assistance through phone interactions and administrative support

• Offer compassionate, member-focused assistance and respond to questions with empathy

• Screen incoming calls, faxes, and other digital requests related to Utilization Management and/or Case Management

• Route requests to the appropriate departments and refer cases to Case Management and/or Transition of Care

• Receive, investigate, and resolve customer queries and claims

• Achieve departmental goals and undertake assigned projects, reviews, and reports

• Load comprehensive organization determinations/notifications for services in line with internal policy

• Document and input data into the relevant system following departmental guidelines

• Engage with members, hospital personnel, and provider staff regarding Utilization Management decisions and organization determination status

• Request further or clarifying information and provide guidance as necessary

• Search for and input relevant diagnosis and/or procedure codes during notification/prior authorization processes

• Work overtime as needed

⛳️ Requirements

• High School Diploma or equivalent is required

• Minimum of 1 year of customer service experience

• Proficiency in Microsoft Office (Outlook, Word, Excel, and PowerPoint)

• Strong oral and written communication skills

• Excellent interpersonal and organizational abilities

• Outstanding time management skills

• Capacity to work independently under general supervision as well as collaboratively in a team within a fast-paced environment

• Independent, sound judgment and problem-solving capabilities

• Comprehensive knowledge of all facets of Utilization Management, Care Management, and Behavioral Health

• Familiarity with medical terminology

• In-depth understanding of provider reimbursement methodologies, ICD-10-CM, CPT, HCPCS, and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic

• Ability to converse and type simultaneously in a clear and concise manner while engaging with customers

• Willingness to work weekly rotating shifts from 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

• Completion of a digital literacy assessment is required

• Mandatory participation and attendance

• Flexibility and compliance with assigned schedules

• Current employees must meet minimum performance standards

🏝️ Benefits

• Opportunity for remote work within a collaborative and supportive team environment

• Overtime may be required based on business needs