Clinical Assistant needs 2 plus years of experience into customer service, medical terminology, and history with medical related jobs. Clinical Assistant requires: • High School Diploma or equivalent Experience • COVID vaccinated maybe required • 1 year - Customer service experience is required Skills\Certifications • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) • Proficient oral and written communication skills o Proficient interpersonal and organizational skills o 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-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 • Participation and attendance are mandatory. • Requires flexibility, due to rotations in schedules, and requires adherence to assigned schedules. • Clinical Assistant duties: • Screen incoming calls and/or faxes or other digital format 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. • Receive, investigate and resolve 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 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.