Pre-Certification Specialist Behavioral Health - Remote (PA/NJ/DE)

Independence Blue Cross; Philadelphia (Philadelphia County); Remote; USD 45,000 - 65,000; Full time

Job summary

A healthcare company is seeking a fully remote Precertification Specialist to process behavioral health precertification requests and verify member eligibility. The ideal candidate will possess excellent organizational skills, prior customer service experience, and familiarity with medical insurance procedures. This role requires strong verbal and written communication abilities and flexibility in a high-volume call center environment.

Qualifications

• Excellent organizational, interpersonal, verbal, and written communication skills required.
• Detail oriented with an ability to accept and respond to change.
• Previous customer service experience is required.
• Previous medical insurance experience is highly recommended.

Responsibilities

• Answers calls from members and health care professionals regarding precertification requests.
• Verifies member eligibility using multiple systems.
• Processes precertification requests from members and providers.
• Adheres to departmental standards for time and productivity.

Skills

Organizational skills

Verbal communication

Written communication

Proficiency in Microsoft Word

Ability to learn new systems

Education

Bachelor’s degree

Tools

Microsoft Office Suite

Adobe programs

Job description

Overview

Under the direction of a Supervisor, Health Resources Center, the Precertification Specialist processes Behavioral Health precertification requests in accordance with established corporate guidelines and in compliance with all state and federal regulations.

Responsibilities

• Answers incoming telephone calls in a high-volume Call Center environment from members and health care professionals regarding requests for precertification of behavioral 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 but not limited to the National Provider Identification (NPI) Registry.
• Processes precertification requests from members and providers received telephonically, via fax or the Provider portal 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 investigative/experimental procedures.
• Adheres to the departmental standards for staff time, after call work, attendance, and non-queue productivity.
• Adheres to the corporate quality customer-focused professionalism and accuracy standards.
• Responds to all forms of communication promptly and as necessary.
• Performs additional duties as assigned.

Qualifications

• Excellent organizational, interpersonal, verbal, and written communication skills required.
• Detail oriented with an ability to accept and respond to change.
• Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs.
• Ability to learn new systems as technology advances.

Education And Experience

• Bachelor’s degree preferred, but not required.
• Previous experience in social work or related field recommended.
• Previous customer service experience is required.
• Previous medical insurance experience is highly recommended, behavioral health experience a plus.
• Coding knowledge recommended.

Fully Remote

This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.