Remote Clinical Assistant - Global Channel Management, Inc

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.

•

Clinical Assistant duties:

• 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.