Clinical Assistant

BlueCross BlueShield of Tennessee

Clinical Assistant supporting BlueCare Plus Clinical Review Managers at BCBST. Key point of contact for providers and healthcare partners in a remote role.

Posted 7/28/2026full-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 methodologies including ICD-10-CM, CPT, and HCPCS. Excels in customer service, effective communication, and problem-solving in a fast-paced environment.

Highest-signal resume keywords

Utilization ManagementCare ManagementICD-10-CM CodingCustomer Service ExperienceMicrosoft Office Proficiency

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

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

Hard Skills

ICD-10-CM CodingCPT CodingHCPCS CodingUB-92 CodingUHDDS Coding GuidelinesAHA Coding Clinic KnowledgeData EntryOrganization DeterminationPrior Authorization ProcessMedical Terminology

Soft Skills

Oral CommunicationWritten CommunicationInterpersonal SkillsOrganizational SkillsTime ManagementDecision-MakingProblem-SolvingTeam CollaborationIndependent Work

Tools & Technologies

Microsoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPoint

Industry Keywords

Utilization ManagementCare ManagementBehavioral HealthProvider Reimbursement Methodologies

About the role

Key responsibilities & impact

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, requesting additional or clarifying information and giving direction as necessary.
Search for and key appropriate diagnosis and /or procedure code as part of the notification /prior authorization process.

Requirements

What you’ll need

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
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

Benefits

Comp & perks

Health insurance 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score