Clinical Assistant needs 2 plus years of experience into customer service, medical terminology, and history with medical related jobs. Clinical Assistant requires: 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. 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. #J-18808-Ljbffr
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