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Clinical Assistant

5 months ago

Chattanooga, United States Net2Source Inc. Full time

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 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, 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.


Responsibilities:

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 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.


Must have:

· Solid knowledge and understanding of provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic

· 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.

· Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)