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    Clinical Assistant - Chattanooga, United States - Talent Software Services

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    Description

    Location:
    Chattanooga,TN -100% Remote


    Start Date:
    Jan 2023

    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 Description

    Job Responsibilities

    o 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.
    o Receiving, investigating and resolving customer inquiries and claims. Maintain departmental goals. Perform projects, review and handle reports as assigned.
    o Load complete organization determination/notification for services designed by internal policy. Clearly document and key data in to the appropriate system using departmental guidelines.

    o Interact with membership, hospital and provider staff, advising of UM decision, status organization determinations, giving direction as necessary.

    o Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.

    o Must be able to pass required testing.
    o Participation and attendance are mandatory.
    o This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.
    o Work overtime as required

    Quals ll applicants will be advised that Client, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.


    Job Qualifications
    Education
    o High School Diploma or equivalent
    Experience
    o 1 year - Customer service experience is required
    Skills\Certifications
    o Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
    o Proficient oral and written communication skills
    o Proficient interpersonal and organizational skills
    o Exceptional time management skills
    o Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment
    o Independent, Sound decision-making and problem-solving skills
    o If current employee with the company, must meet minimum performance expectations
    o Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health.
    o Knowledge and understanding of Medical terminology
    o Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic
    o Ability to talk and type simultaneously in a clear and concise manner while interacting with customers

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