Clinical Assistant

Title: Clinical Assistant

Location: Remote

Duration: 3 months

Shift: 8:00am to 5:00pm

Job Qualifications:

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 several 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.