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 Description : Job Responsibilities

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, 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.
• 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

Job Qualifications

Education

High School Diploma or equivalent

Experience

1 year - Customer service experience is required

Skills Certifications

• 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 Specific Requirements :

Stong preference for Utilization Management experience.

Preferred Skills :

Number of Openings Available :

Worker Type : Employee

Employee

Company :

VSHP Volunteer State Health Plan, Inc

Remote-First Statement :

BCBST hires employees for remote positions from across the U.S. with the exception of the following states : California, Massachusetts, New Hampshire, New Jersey, and New York.

Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.

If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.

Applying for this job indicates your acknowledgement and understanding of the following statements :

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made.

BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies / Notices may be found by reviewing the following page :

BCBST's EEO Policies / Notices (https : / / www.bcbst.com / docs / equal-employment-opportunity.pdf)

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.

All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR / Talent Acquisition will not be considered.

No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits.

A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community.

All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco / nicotine test.

An individual whose post offer screening result is positive for illegal drugs or tobacco / nicotineand / or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco / nicotine products include smokefree.gov or 1-800-QUIT-NOW.

About Us

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years.

More than that, we're your neighbors and friends - fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.

BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based.

BCBST hires employees for remote positions from across the U.S. with the exception of the following states : California, Massachusetts, New Hampshire, New Jersey, and New York.

Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.

If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.

Last updated : 2024-05-16