9 Pre-Certification Specialist Jobs in Philadelphia, PA
Independence Blue Cross is Hiring a Pre-Certification Specialist Near Philadelphia, PA
Under the direction of a manager and licensed health professionals, the Pre-Cert Specialist processes precertification requests in accordance with established corporate guidelines and in compliance with all state and federal regulations.
Major Activities:
- Answers incoming telephone calls in a high-volume Call Center environment from members and health care professionals regarding requests for precertification of health services.
- Verifies member eligibility by accessing multiple eligibility systems
- Verifies participation status of professional and facility providers, by product and state utilizing multiple database systems including the National Provider Identification(NPI) Registry
- Processes precertification requests from members and providers received telephonically, via fax or NaviNet per department guidelines
- Obtains all clinical information including procedure and diagnosis codes
- Enters all pertinent data in the appropriate computer system
- Approves selected services per departmental guidelines
- Identifies precertification requests that warrant a medical necessity review
- Identifies potentially cosmetic and investigative/experimental procedures
- Adheres to the departmental standards for staff time, after call work, attendance and non-queue production
- Adheres to the corporate quality customer-focused professionalism and accuracy standards
- Responds to voicemails and emails within one business day, as necessary
- Performs additional duties as assigned
- High school diploma required, associate degree in a related field preferred.
- A minimum of three years of customer service experience in the health insurance industry or health services industry strongly recommended including knowledge of medical terminology, a general understanding of managed care delivery systems and a familiarity with ICD9/ICD10 and CPT codes.
- Excellent organizational, interpersonal, verbal and written communication skills, necessary
- Detailed oriented with an ability to accept and respond to changes.
- Experience accessing, navigating, and data entering into computerized databases required. Specifically, Word, Excel, and Mainframe
- Knowledge of INSINQ is a plus
- Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Job Summary
Full Time
$77k-118k (estimate)
06/22/2024
07/10/2024
ibx.com
CEDAR GROVE, NJ
7,500 - 15,000
1938
DON MUZICH
$1B - $3B
Wholesale
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About Independence Blue Cross
Independence Blue Cross is the leading health insurance organization in southeastern Pennsylvania. With our affiliates, we serve nearly 8.5 million people in 25 states and Washington, D.C., including more than 2.5 million in the region. For nearly 80 years, we have been enhancing the health and well-being of the people and communities we serve by delivering innovative and competitively priced health care products and services; pioneering new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and supporting programs and events that promote well...-being. To learn more visit www.ibx.com. Connect with us on Facebook and Twitter. Independence Blue Cross is a subsidiary of Independence Health Group, Inc. independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.
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The following is the career advancement route for Pre-Certification Specialist positions, which can be used as a reference in future career path planning. As a Pre-Certification Specialist, it can be promoted into senior positions as a Member Certification Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Pre-Certification Specialist. You can explore the career advancement for a Pre-Certification Specialist below and select your interested title to get hiring information.
