Pre-Certification Specialist

Job Summary

Processing precertification requests in a fully remote capacity, the Pre-Certification Specialist will manage incoming calls from members and healthcare professionals, verify eligibility, and ensure compliance with corporate guidelines and regulations.

Key responsibilities

• Handle high-volume calls regarding precertification requests from members and providers
• Verify member eligibility and provider participation status using multiple database systems
• Process precertification requests and obtain necessary clinical information for approvals

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 computerized databases, including Word, Excel, and Mainframe
• Knowledge of INSINQ is a plus