Call Center Specialist - Health Services | 100% Remote | Contract-to-Hire

Call Center / Pre-Certification Specialist

Contract-to-Hire Pay rate: $23/HR W2 Location: 100% Remote but required to be in tri-state area (PA, NJ, DE)

Looking for candidates who are well versed in call center and comfortable in high call volume settings. Managers are requesting that candidates have a laptop, monitor and headset for this assignment.

Position Summary

Under the direction of a Supervisor the HRC Precert Specialist processes precertification requests in accordance with established corporate guidelines and in compliance with all state and federal regulations.

Major Activities

Answers incoming telephone calls in a high-volume Call Center environment from members and health care professionals regarding requests for precertification of health services.

1. Verifies member eligibility by accessing multiple eligibility systems
2. Verifies participation status of professional and facility providers, by product and state utilizing multiple database systems including the National Provider Identification(NPI) Registry
3. Processes precertification requests from members and providers received telephonically, via fax or the PEAR 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 cosmetic and investigative/experimental procedures
4. Adheres to the departmental standards for staff time, after call work, attendance and non-queue productivity
5. Adheres to the corporate quality customer-focused professionalism and accuracy standards
6. Responds to voicemails and emails within one business day, as necessary
7. Performs additional duties as assigned.

Education and Experience

• 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 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 various computer databases required.

Please apply with your interest. You may also reach out to me at View email address on click.appcast.io Thank you, Ashu

We provide a comprehensive package which includes Benefits: Medical for full time employees, Dental, and Vision Insurance, Life Insurance, Short-Term Disability, Long-Term Disability, etc.