Description: Clinical Assistant - Supports customer service activities and initiatives for a number of products or clients including but not limited to the Case Management and Utilization Management departments. Job Qualifications: 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 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-9-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 Job 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, giving direction as necessary. Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process. Must be able to pass required testing. Participation and attendance are mandatory. This position requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules. Work overtime as required Skills & Qualifications: MA and bilingual are a plus Appeals and/or Grievance Preferred. Experience Level: Entry Level About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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