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Our client, a prominent healthcare organization in the Philly area, is seeking a contracted Precertification Specialist to join their team. This remote position supports members and healthcare professionals by processing precertification requests with accuracy, professionalism, and adherence to all regulatory requirements. Candidates must reside in the Tri-State area.
About the Job
- Respond to high-volume inbound calls from members and healthcare professionals regarding precertification requests.
- Verify member eligibility and provider participation status across multiple systems, including the NPI Registry.
- Process precertification requests received via phone, fax, or online portal per departmental guidelines.
- Collect and enter clinical data such as procedure and diagnosis codes accurately into the system.
- Approve selected services based on departmental criteria and identify cases requiring medical necessity review.
- Recognize potentially cosmetic or investigational procedures for further review.
- Maintain compliance with corporate standards for accuracy, professionalism, and productivity.
- Respond to voicemails and emails within one business day and complete assigned administrative tasks promptly.
About You
- High school diploma required; associate degree in a related field preferred.
- At least 3 years of customer service experience within the health insurance or healthcare industry.
- Strong knowledge of medical terminology, managed care systems, ICD-10, and CPT codes.
- Proficient in navigating and entering data into multiple computer systems.
- Excellent communication, organizational, and problem-solving skills.
- Highly detail-oriented with the ability to adapt to change and manage competing priorities.
This is a contracted, remote position available to candidates residing in Pennsylvania, New Jersey, or Delaware.
Offering $23.00 per hour with remote flexibility, the role offers a collaborative environment with opportunities to work alongside industry professionals. Apply today with your Word resume to join a mission-driven healthcare organization focused on service and quality!
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