Clinical Assistant

3 weeks ago

Memphis, United States Syntricate Technologies Full time

Remote- 1st preference will bel local to TN to get shortlisted and get interviewes and 2nd preference will be from BCBST approved states which are below.

Qualifications:

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

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 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

Comments/Special Instructions

ppeals and/or Grievance Preferred. Experience with Dual - SNP plans preferred.

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