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BlueCross BlueShield of Tennessee · 7 hours ago

Clinical Assistant

United States

Full-time

Remote

Entry Level

1+ years exp

BlueCross BlueShield of Tennessee is seeking a Clinical Assistant to join their Senior Care team. In this remote-first role, you'll support members and providers by managing authorization requests and addressing related questions based on plan coverage.

Health CareMedical

H1B Sponsor Likely

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

Qualification

Medical customer serviceICD-10 codesUtilization ManagementMicrosoft OfficeMedical terminologyProvider reimbursement methodologiesOralWritten communicationInterpersonal skillsOrganizational skillsTime managementDecision-making skillsProblem-solving skills

Required

High School Diploma or equivalent

1 year - Customer service experience is required

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

Company

BlueCross BlueShield of Tennessee

Glassdoor3.8

As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years.

Founded in 1945

Chattanooga, Tennessee, USA

5001-10000 employees

http://www.bcbst.com

H1B Sponsorship

BlueCross BlueShield of Tennessee has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (26)

2024 (38)

2023 (36)

2022 (44)

2021 (56)

2020 (58)