Pre-Certification Specialist

Job Summary

A company is looking for a Pre-Certification Specialist.

Key Responsibilities:

• Processes precertification requests and verifies member eligibility in a high-volume call center
• Enters pertinent data into computer systems and approves selected services per departmental guidelines
• Identifies requests for medical necessity reviews and adheres to departmental standards for quality and professionalism

Required Qualifications:

• High school diploma required; associate degree in a related field preferred
• Minimum of three years of customer service experience in the health insurance or health services industry
• Knowledge of medical terminology and familiarity with ICD9/ICD10 and CPT codes
• Experience with data entry and navigating computerized databases
• Knowledge of INSINQ is a plus