Precertification Specialist

Required Skills and Experience:

• Medical Terminology or medical background such as nursing assistant/tech or doctor office experience
• Customer Service experience
• Exceptional phone skills
• Administrative/PC skills

Highly preferred:

• Provide high quality, member focused servicing using knowledge of plans, products, systems, and procedures to meet or exceed member experience
• Assist in locating primary care physicians,specialists and dentists
• Thoroughly explain wellness care management program benefits to members
• Work as a team member to assist nurses in researching providers, eldercare, nursing homes
• Concisely and accurately enter documentation into Care Advance
• Effectively engage over the phone via both inbound and outbound members that qualify for our clinical programs or those who are interested in learning more about our services
• Refer and/or warm transfer to wellness and care management components and other areas and vendors as needed.
• Process provider requests as needed.
• Act as member¿s first trusted source for WCM programs
• Schedule appointments between the member and coach in appropriate systems
• Assign referrals to designated staff
• Process requests for compliance inquiries
• Access various WCM department mailboxes and voicemail as needed
• Ability to function independently
• Critical Thinking
• Quick learner
• Bi-Lingual/Spanish

Category Clerical

Function Clerical / Administrative

Req ID JN