Clinical Assistant

Job Title: Clinical Assistant
Location: Chattanooga, TN 37402
Duration: Contract

Qualifications:

• All applicants May be required to implement a COVID-19 vaccine mandate.

Education:

• High School Diploma or equivalent Experience.
• 1 year - Customer service experience is required .

Skills\Certifications:

• 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.
• If current employee 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, 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

Responsibilities:

• Job Profile Summary 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.
• 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. o 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 Type: Contract

Work Location: In person