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The BlueCare Utilization Management is excited to expand our team with a **Clinical Assistant\.** In this position, you will be responsible for handling incoming calls related to prior authorizations, entering demographic information in coordination with the clinical team, and addressing Customer Service inquiries, among other essential duties\. If you're detail\-oriented, thrive in a fast\-paced setting, and enjoy working alongside a dedicated clinical team, we’d love to hear from you\!

**You will be a great match for this role if you have** :

+ 1\+ years of Customer Service and Claims experience

+ Non\- Clinical Utilization Management experience

+ Facets, Care Advance experience and Agent Workspace experience

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 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

_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\-10\-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

Number of Openings Available

1

Worker Type:

Employee

Company:

VSHP Volunteer State Health Plan, Inc

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law\.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices \(https://www\.bcbst\.com/docs/equal\-employment\-opportunity\.pdf\)

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity\. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via\-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered\. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means\.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945\. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow\.

At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members\. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability\.

We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously\. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST\.

BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\.

BCBST hires employees for remote positions from across the U\.S\. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York\. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance\.