Job Description

Position Title: Clinical Assistant

Location: Remote

Duration: 3 Months

Schedule: 8:00 AM 5:00 PM

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.

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 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 the 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

Qualifications:

• High School Diploma or equivalent
• 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

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