Clinical Assistant-2 (Healthcare)

TL;DR

Clinical Assistant-2 (Healthcare): Supporting BlueCare Clinical Support by serving TennCare members with an accent on provider support and administrative workflow management. Focus on coordinating UM/CM requests, managing medical coding documentation, and resolving customer inquiries.

Location: Remote (USA). Requires availability for rotating shifts between 7:45 a.m. ET and 6:00 p.m. ET to meet Tennessee state coverage requirements.

Company

hirify.global is a major health insurance provider dedicated to serving members across the state of Tennessee.

What you will do

• Screen and direct incoming calls and faxes for Utilization Management (UM) and Case Management (CM) to the appropriate departments.
• Investigate and resolve customer inquiries and claims while maintaining departmental goals.
• Process and document organization determinations and notifications according to internal policies.
• Collaborate with hospital and provider staff to advise on UM decisions and request clarifying information.
• Assign and key appropriate diagnosis and procedure codes as part of the prior authorization process.
• Utilize AI-enabled tools and digital systems to maintain accurate and efficient clinical workflows.

Requirements

• High School Diploma or equivalent.
• 1 year of customer service experience.
• Proficiency in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
• Knowledge of medical terminology and provider reimbursement methodologies.
• Understanding of ICD-10-CM, CPT, HCPCS, and UB-92 coding guidelines.
• Ability to work rotating shifts and adhere to assigned schedules (Eastern Time).

Culture & Benefits

• Collaborative and supportive team environment.
• Structured training and preceptor period, typically completed in six weeks.
• Culture of innovation encouraging the responsible use of AI tools to transform member service.
• Stable full-time employment within a professional healthcare organization.