Clinical Assistant

• 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