Location
Chattanooga, TN | United States
Job description
Job Title: Clinical Assistant
Location: Chattanooga TN 37402 Remote
Duration: 6 Months
Shift: 8:00am to 5:00pm
Education:
- High School Diploma or equivalent
Experience:
- 1 year Customer service experience is required.
SkillsCertifications:
- 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 challenging environment.
- Independent Sound decisionmaking and critical thinking skills
- If a current employee is with the company must meet minimum performance expectations.
- 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 ICD9CM CPT HCPCS and UB92 coding UHDDS coding guidelines AHA Coding Clinic
- Ability to talk and type simultaneously in a clear and concise manner while interacting with customers.
Responsibilities:
Job Profile Summary
- Supports customer service activities and initiatives for a few products or clients including but not limited to the Case Management and Utilization Management departments.
Job Responsibilities:
- 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 into the appropriate system using departmental guidelines.
- Interact with membership hospital and provider staff advising of UM decision status organization determinations giving direction as necessary.
- Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.
- Must be able to pass required testing.
- Participation and attendance are mandatory.
- This position requires flexibility due to rotations in schedules and requires adherence to assigned schedules.
- Work overtime as required.
Comments/Special Instructions:
- Appeals and/or Grievance Preferred.
- Experience with Dual SNP plans preferred.
Job tags
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