Call Center Specialist - Health Services | 100% Remote | Contract-to-Hire

Call Center / Pre-Certification SpecialistContract-to-Hire Pay rate: $23/HR W2 Location: 100% Remote but required to be in tri-state area (PA, NJ, DE)Looking for candidates who are well versed in call center and comfortable in high call volume settings. Managers are requesting that candidates have a laptop, monitor and headset for this assignment.Position SummaryUnder the direction of a Supervisor the HRC Precert Specialist processes precertification requests in accordance with established corporate guidelines and in compliance with all state and federal regulations.Major ActivitiesAnswers incoming telephone calls in a high-volume Call Center environment from members and health care professionals regarding requests for precertification of health services.Verifies member eligibility by accessing multiple eligibility systemsVerifies participation status of professional and facility providers, by product and state utilizing multiple database systems including the National Provider Identification(NPI) RegistryProcesses precertification requests from members and providers received telephonically, via fax or the PEAR portal per department guidelines Obtains all clinical information including procedure and diagnosis codesEnters all pertinent data in the appropriate computer systemApproves selected services per departmental guidelinesIdentifies precertification requests that warrant a medical necessity reviewIdentifies potentially cosmetic and investigative/experimental proceduresAdheres to the departmental standards for staff time, after call work, attendance and non-queue productivityAdheres to the corporate quality customer-focused professionalism and accuracy standardsResponds to voicemails and emails within one business day, as necessaryPerforms additional duties as assigned.Education and ExperienceHigh school diploma required, associate degree in a related field preferred.A minimum of three years of customer service experience in the health insurance industry or health services industry strongly recommended including knowledge of medical terminology, a general understanding of managed care delivery systems and a familiarity with ICD10 and CPT codes.Excellent organizational, interpersonal, verbal and written communication skills, necessaryDetailed oriented with an ability to accept and respond to changes.Experience accessing, navigating, and data entering into various computer databases required.Please apply with your interest. You may also reach out to me at Thank you, AshuWe provide a comprehensive package which includes Benefits: Medical for full time employees, Dental, and Vision Insurance, Life Insurance, Short-Term Disability, Long-Term Disability, etc.