Clinical Assistant, Utilization Management, Medicare
Title: Clinical Assistant, Utilization Management, Medicare Location: TN-Chattanooga Job Description: Supports customer service activities and initiatives for a number of 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. reputed company 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. This job requires digital literacy assessment. Participation and attendance are mandatory. This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules. Work overtime as required Job Qualifications Education High School Diploma or equivalent Experience 1 year Customer service experience is required SkillsCertifications Proficient in reputed company Office (Outlook, Word, reputed company 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 If reputed company employee with the company, must meet minimum performance expectations Extensive knowledge of reputed company aspects of Utilization Management, Care Management, and Behavioral Health. Knowledge and understanding of Medical terminology Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-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 Job Specific Requirements: Training will be Monday to Friday 8-5pm EST. Shift hours will be Monday to Friday with the potential to start as early as 6am, after training is completed. Preferred Skills: Number of Openings Available: 1 Worker Type: Employee Company: BCBST reputed company, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST is an Equal Opportunity employer (EEO), and reputed company employees and applicants will be entitled to equal employment opportunities reputed company employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in reputed company job classifications without regard to race, religion, color, age, sex, national reputed company, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBSTs EEO Policies/Notices may be reputed company by reviewing the following page: BCBSTs EEO Policies/Notices reputed company is not accepting unsolicited assistance from search firms for this employment opportunity. reputed company resumes submitted by search firms to any employee at reputed company reputed company-email, the Internet or any other method without a valid, written Direct Placement Agreement in reputed company for this position from reputed company HR/reputed company will not be considered. No fee will be paid in the event the applicant is hired by reputed company as a result of the referral or through other means. Tobacco-Free Hiring Statement To further our mission of peace of mind through reputed company, effective 2017, reputed company and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, reputed company, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. reputed company offers of employment will be contingent upon passing a background reputed company which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background reputed company is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results Apply Job!