Clinical Assistant-2

BlueCross BlueShield of Tennessee•Chattanooga, TN

7d•Remote

About The Position

We are hiring a Clinical Assistant at BCBST! In this role, you will support BlueCare Clinical Support by serving TennCare members across Tennessee as part of a collaborative team. You will help maintain timely, accurate workflows that support effective service delivery and a positive member experience. This position combines phone-based provider support with fax-based administrative responsibilities. You will communicate with providers to address questions and support requests while also managing fax requests and supporting clinical operations through accurate and efficient workflow management. The role offers a balance of communication, problem-solving, and administrative work in a fast-paced environment where quality, accuracy, and teamwork are essential. The ideal candidate is a quick learner who is productive, goal-oriented, open-minded, adaptable to change, detail-oriented, and committed to a strong work ethic and integrity. Success in this role requires the ability to adjust to changing priorities, become comfortable working across both phone and fax workflows, and remain focused on quality and productivity. Familiarity with medical terminology is preferred. We foster a culture where innovation is encouraged. That includes using AI-enabled tools responsibly to support everyday work—guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members. Note: This is a remote role within a collaborative and supportive team environment. Team members rotate weekly among three shifts. The earliest shift begins at 7:45 a.m. ET, and the latest shift ends at 6:00 p.m. ET to meet State of Tennessee coverage requirements. The role includes a structured training and preceptor period, with full training typically completed in approximately six weeks.

Requirements

High School Diploma or equivalent
1 year - Customer service experience is required
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Proficient oral and written communication skills
Proficient interpersonal and organizational skills
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
If current employee with the company, must meet minimum performance expectations
Ability to talk and type simultaneously in a clear and concise manner while interacting with customers

Nice To Haves

Familiarity with medical terminology is preferred.
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-10-CM, CPT, HCPCS and UB-92 coding, UHDDS coding guidelines, AHA Coding Clinic

Responsibilities

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.
Receiving, investigating and resolving 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 UM decision, status organization determinations, requesting additional or clarifying information and giving direction as necessary.
Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.
This job requires digital literacy assessment. Participation and attendance are mandatory.
This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules.
Work overtime as required