Clinical Assistant

BlueCross BlueShield of Tennessee

. Support BlueCare Clinical Support by serving TennCare members across Tennessee .

Posted 10/9/2026full-timeRemote • Tennessee • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Utilization Management and Care Management, with strong skills in customer service, data entry, and medical coding. Proficient in Microsoft Office and capable of managing workflows to ensure effective service delivery.

Highest-signal resume keywords

Utilization ManagementCustomer Service ExperienceICD-10-CM CodingMicrosoft Office ProficiencyTime Management Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Utilization ManagementICD-10-CM CodingCPT CodingHCPCS CodingUB-92 CodingData EntryMedical TerminologyWorkflow ManagementProvider Reimbursement MethodologiesDigital Literacy

Soft Skills

Oral Communication SkillsWritten Communication SkillsInterpersonal SkillsOrganizational SkillsProblem-Solving Skills

Tools & Technologies

Microsoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPoint

Industry Keywords

Care ManagementBehavioral HealthCustomer InquiriesClaims ResolutionOrganization Determination

About the role

Key responsibilities & impact

Support BlueCare Clinical Support by serving TennCare members across Tennessee
Maintain timely, accurate workflows supporting effective service delivery and a positive member experience
Provide phone-based provider support
Manage fax requests and support clinical operations through accurate and efficient workflow management
Screen incoming calls, faxes, and other digital requests for Utilization Management and/or Case Management
Direct calls, faxes, and digital requests to the appropriate area
Identify and refer cases appropriately to Case Management and/or Transition of Care
Receive, investigate, and resolve customer inquiries and claims
Maintain departmental goals and perform assigned projects, reviews, and reports
Load complete organization determinations/notifications for services according to internal policy
Document and enter data into the appropriate system using departmental guidelines
Interact with members, hospital staff, and provider staff regarding Utilization Management decisions and organization determination status
Request additional or clarifying information and provide direction as necessary
Search for and enter appropriate diagnosis and/or procedure codes as part of the notification/prior authorization process
Rotate weekly among three shifts to meet State of Tennessee coverage requirements

Requirements

What you’ll need

High School Diploma or equivalent
1 year of 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
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
Ability to talk and type simultaneously in a clear and concise manner while interacting with customers
Digital literacy assessment required
Participation and attendance are mandatory
Flexibility due to rotating schedules and adherence to assigned schedules
Ability to work overtime as required

Benefits

Comp & perks

Remote work
Structured training and preceptor period
Full training typically completed in approximately six weeks