Job Description

We are hiring a Clinical Assistant at BCBST!

In this role, you will support BlueCare Clinical Support by serving TennCare members across Tennessee as part of a collaborative team. You will help maintain timely, accurate workflows that support effective service delivery and a positive member experience.

This position combines phone-based provider support with fax-based administrative responsibilities. You will communicate with providers to address questions and support requests while also managing fax requests and supporting clinical operations through accurate and efficient workflow management. The role offers a balance of communication, problem-solving, and administrative work in a fast-paced environment where quality, accuracy, and teamwork are essential.

The ideal candidate is a quick learner who is productive, goal-oriented, open-minded, adaptable to change, detail-oriented, and committed to a strong work ethic and integrity. Success in this role requires the ability to adjust to changing priorities, become comfortable working across both phone and fax workflows, and remain focused on quality and productivity. Familiarity with medical terminology is preferred.

We foster a culture where innovation is encouraged. That includes using AI-enabled tools responsibly to support everyday work—guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve

members.

Note:

• This is a remote role within a collaborative and supportive team environment.
• Team members rotate weekly among three shifts. The earliest shift begins at 7:45 a.m. ET, and the latest shift ends at 6:00 p.m. ET to meet State of Tennessee coverage requirements.
• The role includes a structured training and preceptor period, with full training typically completed in approximately six weeks.

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.
• This job requires digital literacy assessment.
• 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

SkillsCertifications

• 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-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

Number of Openings Available

1

Worker Type:

Employee

Company:

VSHP Volunteer State Health Plan, Inc

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

BCBST will 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

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.