Clinical Assistant

Clinical Assistant needs 1 years experience in a customer service support role is required

Clinical Assistant requires:

• Customer service support role is required
• Certifications
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient interpersonal and organizational skills
• Independent, Sound decision-making and problem-solving skills
• Healthcare environment
• Provider reimbursement methodologies, ICD-9-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic
• Must be able to work in an independent and creative manner.
• Self-motivated and able to manage multiple tasks and set priorities.
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Knowledge in Medical terminology
• Various immunizations and/or associated medical tests may be required
• Supports area clinical team and serves as a proactive resource for members related to disease prevention and benefit education.
• Conduct educational telephone calls advising members of available benefits, services and programs; completes health needs assessment, and refers members to population health management programs as appropriate.
• Reach out to members with identified gaps in care; encouraging and motivating them to become compliant; offering assistance in locating providers and appointment scheduling.
• Manage system work queues; screening identified members for eligibility, prior case activities, recent claims, customer service inquiries and authorization history; assigning members to clinical team for call outreach and intervention.
• Facilitate research and analysis of inquiries and/or complaints related to processes and designations, member lost incentives, and other program related inquiries