Precertification Specialist

A company is looking for a Pre-Certification Specialist to handle precertification requests in a call center environment.

Key Responsibilities

Answer incoming calls from members and healthcare professionals regarding precertification requests

Verify member eligibility and provider participation status using multiple database systems

Process precertification requests received via phone, fax, or online portal according to department guidelines

Required Qualifications

High school diploma required; associate degree in a related field preferred

Minimum of three years of customer service experience in the health insurance or health services industry

Knowledge of medical terminology and familiarity with ICD10 and CPT codes

General understanding of managed care delivery systems