Precertification Specialist


Strategic Staffing Solutions


Strategic Staffing Solutions is currently looking for a Bilingual 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) Must be local to Detroit, MI for consideration. 

Duration: 12+ Months

Role Type: W2 Contract Engagement

Rate: $18/hr

*Must be within a reasonable proximity to Detroit.

*Anticipated work hours vary between 8:00a.m. – 8:00p.m. (to include rotating Saturdays, holidays, and overtime as needed).

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:

  • 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 client areas and vendors as needed
  • Process provider requests as needed
  • Act as member’s 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
  • Bi-Lingual/Spanish

Job ID: JOB-236240
Publish Date: 28 Jun 2024

Tagged as: Precertification Specialist