Clinical Assistant

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

📋 Description

• Assist BlueCare Clinical Support by providing services to TennCare members throughout Tennessee

• Ensure timely and accurate workflows to promote effective service delivery and enhance member experience

• Offer phone-based support to providers

• Handle fax requests and aid clinical operations through precise and efficient workflow management

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

• Route calls, faxes, and digital requests to the appropriate departments

• Identify and appropriately refer cases to Case Management and/or Transition of Care

• Receive, investigate, and resolve customer inquiries and claims

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

• Load complete organization determinations/notifications for services in accordance with internal policies

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

• Communicate with members, hospital staff, and provider staff regarding decisions in Utilization Management and the status of organization determinations

• Request additional or clarifying information and provide guidance as necessary

• Search for and input the appropriate diagnosis and/or procedure codes as part of the notification/prior authorization process

• Rotate weekly among three shifts to fulfill the coverage requirements of the State of Tennessee

⛳️ Requirements

• High School Diploma or equivalent

• A minimum of 1 year of customer service experience is necessary

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

• Strong oral and written communication skills

• Excellent interpersonal and organizational skills

• Outstanding time management abilities

• Capability to work independently under general supervision as well as collaboratively as part of a team in a fast-paced environment

• Independent decision-making and problem-solving skills

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

• Familiarity with medical terminology

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

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

• Digital literacy assessment is required

• Mandatory participation and attendance

• Flexibility is necessary due to rotating schedules and strict adherence to assigned schedules

• Willingness to work overtime as needed

🏝️ Benefits

• Remote work opportunities

• Structured training and preceptor period

• Full training typically completed in about six weeks