Pre-Certification Specialist
Bring your drive for excellence, team orientation and customer commitment to Independence Blue Cross; help us renew and reimagine our business and shape the future of health care. Our organization is looking to diversify, grow, innovate and serve, and we are looking for committed, empowered learning-oriented people to join our team. If this describes you, we want to speak with you.
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.
- 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
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
Vaccination Update
This job requires that you demonstrate you have been fully vaccinated for COVID-19 prior to the start of employment, to the extent permitted by law.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.