G-TECH Services, Inc. WCM/CCM EC/Precert Specialist in Detroit, Michigan
Will this position be required to work onsite for any reason at any time? No
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
- 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.
- Evaluate and identify clinical requests that require medical necessity review and route to
appropriate clinical staff.
- 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
Ability to function independently.
EDUCATION AND/OR EXPERIENCE
Two (2) years of college is preferred.
Experience with benefits and procedures as related to assigned
- Three (3) to five (5) years of experience in the healthcare industry preferred.
Function Clerical / Administrative
Req ID JN -102023-120544