Precertification Specialist

Under the general direction of the Manager, Precertification Programs, this position has overall responsibility for providing accurate and complete data input and application of non-clinical scripted criteria for precertification requests and providing excellent customer service. Specific Position Requirements & Responsibilities: Answer calls from physician offices, hospitals, and patients using exemplary customer service skills. Accurately enter required information (non-clinical and structured clinical data) into computer database. Review structured clinical data matching it against specified medical terms and diagnoses or procedure codes (without the need for interpretation) and follow established procedures for authorizing request or referring request for further review. Attach incoming faxes to appropriate record in iCare and follow established procedures for distributing this information for further review. Notify providers with precertification numbers as needed and process completed precertification requests as per established procedures. Call hospitals for discharge dates as needed. Refer callers to benefit departments of correct claims administrator when requesting benefit information. Process form letters from iCare as directed. Be logged in to the phone queue and available to take calls during scheduled times. As part of the Precert Triage program, provides precertification support to all ICM departments as necessary. Requires extensive use of the telephone (approximately 60% of the work week). Other duties as assigned. Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies: 1-2 years previous experience in medical office setting, precertification position, healthcare management or a related field, providing customer service support required. Strong knowledge of medical terminology, required. Medical coding, billing and/or claims processing experience, preferred. Strong time management, organization, attention to detail skills/abilities. Ability to problem solve/resolve emotionally charged situations or circumstances. Ability to work in a fully remote business setting without distraction or interruption. Strong oral and written communication skills — specifically telephone skills. Ability to stay focused and engaged. Ability to use a computer and quickly learn and master different software platforms as needed to perform assigned tasks and responsibilities. Self-motivated with the ability to take initiative and work effectively in both an independent and collaborative business environment. Demonstrated ability to problem solve multifaceted and/or complex situations. Ability to successfully navigate conflict and reach mutually beneficial solutions. Strong organizational, task prioritization, and delegation skills. Strong focus on patient advocacy and empathy. Education, Licensure, and Certification Requirements: High School Diploma or GED, required. Two years of college, preferred. Work and Physical Conditions: Ability to sit or stand for 6-8 hours per day. Ability to wear a headset, dial, answer, and talk on a telephone for 6-8 hours per day. Ability to sit or stand in front of a computer screen and type on a keyboard 6-8 hours per day. Ability to lift and transport computer, headset, and files between office and home; less than 20 pounds as needed.

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