Job Description

About the job Remote Clinical Assistant


Clinical Assistant needs 2 plus years of experience into customer service, medical terminology, and history with medical related jobs.

• High School Diploma or equivalent Experience
• COVID vaccinated maybe required
• 1 year - Customer service experience is required Skills\Certifications
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Proficient oral and written communication skills o Proficient interpersonal and organizational skills o 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
• 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
• Participation and attendance are mandatory.
• Requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.

• Screen incoming calls and/or faxes or other digital format 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.
• Receive, investigate and resolve 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 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.

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