Pre-Certification Specialist
Independence Blue Cross - Philadelphia, PA

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Position Type:
Full Time

About our Company

The leading health insurer in the Philadelphia region, Independence Blue Cross is a company in motion, continually refining our processes and products to offer the best value to our more than 3.1 million members nationwide. As a pacesetter in the dynamic health care industry, Independence Blue Cross is not only a leader, but also an innovator, growing and expanding into new markets to enhance the health and wellness of the people and communities we serve.

Under the supervision of a
manager and licensed health professionals, the HRC (Health Resource Center) Pre-Certification
Specialist will process pre-certification requests in accordance with
established corporate guidelines and in compliance with all state and federal
regulations. In addition, this position supports all functions of the Healthy
Lifestyles Department.

Major Activities :
Answers incoming telephone calls
in a high volume Call Center environment from members and health care professionals
regarding the Healthy Lifestyles programs and requests for precertification of
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 the National Provider Identification(NPI) Registry
Processes precertification
requests from members and providers received telephonically or via NaviNet per
department guidelines
Processes all requests pertaining
to Healthy Lifestyles incentive programs received telephonically, via fax or
Performs additional duties as assigned

Associates 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. Knowledge of medical terminology, a general
understanding of managed care delivery systems and a familiarity with ICD9 and
CPT-4 codes is also desired.
Excellent organizational,
interpersonal, verbal and written communication skills, necessary.
Detail oriented with an ability
to accept and respond to changes.
Experience accessing, navigating,
and data entering into computerized databases required. Specifically, SLIQ, Word, Excel, and
Knowledge of MaxMC, Pega and GACH
is a plus.

Equal Employment Opportunity

Independence Blue Cross is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, disability, or veteran status.

Agency Disclaimer

All resumes submitted directly to an Independence Blue Cross Family of Companies 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 the Independence Blue Cross Family of Companies . Please note that no fee will be paid in the event the candidate is hired by the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.

About this company
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Independence Blue Cross (IBC) provides health insurance and related services to some 2.2 million members in southeastern Pennsylvania and,...