Under the direction of a Supervisor, Health Resources Center, the Precertification Specialist processes Behavioral Health precertification requests in accordance with established corporate guidelines and in compliance with all state and federal regulations.  

Major Activities:

• Answers incoming telephone calls in a high-volume Call Center environment from members and health care professionals regarding requests for precertification of behavioral health services.
• Verifies member eligibility by accessing multiple eligibility systems
• Verifies participation status of professional and facility providers, by product and state utilizing multiple database systems including but limited to the National Provider Identification (NPI) Registry
• Processes precertification requests from members and providers received telephonically, via fax or the Provider portal per department guidelines  
  • Obtains all clinical information including procedure and diagnosis codes
  • Enters all pertinent data in the appropriate computer system
  • Approves selected services per departmental guidelines
  • Identifies precertification requests that warrant a medical necessity review  
  • Identifies potentially investigative/experimental procedures    
• Adheres to the departmental standards for staff time, after call work, attendance, and non-queue productivity
• Adheres to the corporate quality customer-focused professionalism and accuracy standards
• Responds to all forms of communication promptly and as necessary
• Performs additional duties as assigned

Qualifications

• Excellent organizational, interpersonal, verbal, and written communication skills required  
• Detail oriented with an ability to accept and respond to change.
• Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. 
• Ability to learn new systems as technology advances

Education and Experience:

• Bachelor’s degree preferred, but not required 
• Previous experience in social work or related field recommended  
• Previous customer service experience is required
• Previous medical insurance experience is highly recommended, behavioral health experience a plus
• Coding knowledge recommended.

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential.  We put these principles into action every day by acting with integrity and respect.  Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations.  For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.