Clinical Assistant

BlueCross BlueShield of Tennessee

. Support BlueCare Plus Clinical Review Managers at BCBST .

Posted 9/24/2026full-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 knowledge of medical terminology and coding practices including ICD-10-CM, CPT, and HCPCS. Provides exceptional customer service and support through effective communication and problem-solving skills in a fast-paced environment.

Highest-signal resume keywords

Utilization ManagementCustomer Service ExperienceICD-10-CM CodingMicrosoft Office ProficiencyOral and Written Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementICD-10-CM CodingCPT CodingHCPCS CodingMicrosoft OfficeData EntryMedical TerminologyProvider Reimbursement MethodologiesTime ManagementDigital Literacy

Soft Skills

Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsDecision-Making SkillsEmpathy

Industry Keywords

Care ManagementBehavioral HealthPeer-to-Peer Review ProcessAuthorization RequestsClaims Resolution

About the role

Key responsibilities & impact

Support BlueCare Plus Clinical Review Managers at BCBST
Serve as a key point of contact for providers and healthcare partners
Answer provider questions
Load authorization faxes
Enter authorization requests received by phone
Direct providers through the peer-to-peer review process
Provide timely, accurate support through phone interactions and administrative coordination
Deliver compassionate, member-centered support and respond to inquiries with empathy
Screen incoming calls, faxes, and other digital requests for Utilization Management and/or Case Management
Direct requests to the appropriate area and refer cases 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 determination/notification 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 during notification/prior authorization processes
Work overtime as required

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
Ability to work weekly rotating shifts of 7:30–4:00 p.m., 8:00–4:30 p.m., 8:30–5:00 p.m. and 9:00–5:30 p.m. EST
Digital literacy assessment required
Mandatory participation and attendance
Flexibility and adherence to assigned schedules
If current employee with the company, must meet minimum performance expectations

Benefits

Comp & perks

Remote work within a collaborative and supportive team environment
Overtime may be required based on business needs