Healthcare

Precertification Specialist

Contract

Strategic Staffing Solutions

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!

Strategic Staffing Solutions is currently looking for a Precertification Specialist for a contract opportunity with one of our largest clients located in Detroit, MI!


Title: 
Precertification Specialist

Location: Detroit, MI (Work from home)

Duration: 12+ Months

Role Type: W2 Contract Engagement


Anticipated work hours are between 8:00 a.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
  • Administrative/PC skills

Highly preferred

  • 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 company areas and vendors as needed
  • 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 are met.
  • Ability to function independently.
  • Critical Thinking
  • Quick learner

EDUCATION AND/OR EXPERIENCE

  • Two (2) years of college is preferred.
  • Experience with benefits and procedures as related to assigned department.
  • Three (3) to five (5) years of experience in the healthcare industry preferred.

The S3 Difference

The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities.  The four pillars of our company are to:

  • Set the bar high for what a company should do
  • Create jobs
  • Offer people an opportunity to succeed and change their station in life
  • Improve the communities where we live and work through volunteering and charitable giving

As an S3 employee, you’re eligible for a full benefits package that may include:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • 401(k) Plan
  • Vacation Package
  • Life & Disability Insurance Plans
  • Flexible Spending Accounts
  • Tuition Reimbursement

Job ID: JOB-233939
Publish Date: 12 Feb 2024

Tagged as: Precertification Specialist