WCM/CCM EC/Precert Specialist

1 week ago

Detroit, United States G-TECH Services Full time
Job DescriptionJob Description

WCM/CCM EC/Precert Specialist

 

Anticipated work hours are between 8:00a.m. - 6:00 p.m. (overtime is not required; weekends are expected and include every Saturday on rotation). Remote

 

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:

 

- Triage and resolve inquiries via calls, voicemail messages, electronic systems, or faxes, that are

received from internal and external stakeholders for precertification and appeals.

- Refer and/or warm transfer to wellness and care management components and other BCBSM areas and vendors as needed

 

1.. Perform non-clinical authorizations and letter generation according to the department guidelines.

2. Evaluate and identify clinical requests that require medical necessity review and route to

appropriate clinical staff.

3. Receive medical records, evaluate and prepare cases for clinical review, including determining

group-specific requirements, type of admission, level of review and ensure regulatory timeframes

are met.

 

Ability to function independently.

Critical Thinking

Quick learner

 

EDUCATION AND/OR EXPERIENCE

1. Two (2) years of college is preferred.

2. Experience with benefits and procedures as related to assigned

department.

3. Three (3) to five (5) years of experience in the healthcare industry preferred.

 

Company DescriptionG-TECH Services, Inc. is a leading certified recruitment and placement firm that provides high-quality, flexible staffing solutions to a nationwide client base. We pride ourselves in keeping employee attrition low and offering exciting career opportunities to Engineers and IT professionals We are large enough to make a difference and small enough to genuinely care about each and every one of our employees
We work with the best of the best Join us todayCompany DescriptionG-TECH Services, Inc. is a leading certified recruitment and placement firm that provides high-quality, flexible staffing solutions to a nationwide client base. We pride ourselves in keeping employee attrition low and offering exciting career opportunities to Engineers and IT professionals We are large enough to make a difference and small enough to genuinely care about each and every one of our employees\r
We work with the best of the best Join us today

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