Precertification Specialist
Required Skills and Experience:
Medical Terminology or medical background such as nursing assistant/tech or doctor office experience
Formal education past high school
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 BCBSM areas and vendors as needed
- Process provider requests as needed
- Act as member 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
Category Clerical
Function Clerical / Administrative
Req ID JN -042024-121018