• Job Description

  Req#: 3378832
  Position Summary:
  
  A Precertification Specialist has the overall responsibility for providing accurate and complete data input and application of non-clinical scripted criteria for precertification requests and providing excellent customer service.
  
  This is a remote position; however, due to regulatory and operational requirements, we are only considering candidates who reside in Oregon or Washington State.
  
  Specific Position Requirements & Responsibilities:
  
  Customer Service & Communication
  
  • Answer high volumes of inbound calls from physician offices, hospitals, and patients using excellent customer service skills.
  • Remain logged into the phone queue and available to take calls during scheduled hours.
  • Refer benefit inquiries to the correct claims administrator or benefits department.
  • Notify providers with precertification numbers once determined and process completed precertification requests accordingly.
  • Call hospitals to obtain patient discharge dates when needed.
  
  Data Entry & Documentation
  
  • Accurately enter non-clinical and structured clinical data into the system database.
  • Review structured clinical data and match it against established medical terms or codes; determine next steps based on predefined guidelines.
  • Request additional documentation for pending entries to support timely medical review.
  • Process and send out form letters from iCare as directed.
  
  Fax & Record Management
  
  • Attach incoming faxes to the correct patient record in the documentation system and distribute them per established workflows.
  
  Compliance & Confidentiality
  
  • Maintain strict patient confidentiality in compliance with HIPPA and company policy.
  
  Other Responsibilities
  
  • Perform other duties as assigned.
  
  
  Requirements
  
  Work Experience, Qualifications, Additional Skill and Abilities, and Professional Competencies:
  
  Required:
  
  • 1 to 2 years of experience in a medical office, precertification, healthcare support, or related role.
  • Strong knowledge of medical terminology and basic understanding of diagnosis and procedure codes
  • Ability to manage a high volume of inbound calls in a remote work environment.
  • Demonstrated proficiency in time management, organization, and attention to detail.
  • Ability to maintain confidentiality and comply with HIPAA regulations.
  • Strong verbal and written communication; phone skills essential
  • Ability to communicate clearly, handle sensitive situations professionally, and maintain a customer service mindset.
  • Ability to manage confidential information with discretion and in compliance with HIPAA.
  • Comfortable working in a remote setting with minimal supervision.
  • Self-motivated, adaptable, and a strong team collaborator.
  • Demonstrated empathy and commitment to patient advocacy.
  • Proficient in Microsoft Office Suite and able to learn internal systems.
  
  Preferred:
  
  • Previous experience in medical billing or claims processing.
  • Experience working in a remote call center or TPA setting.
  
  
  Education, Licensure, and Certification Requirements:
  
  Required:
  
  • High School Diploma or GED, required.
  
  Preferred:
  
  • Two years of college or associate degree in a healthcare-related field.
  
  
  Work and Physical Conditions:
  
  • This role is performed remotely. Employees must have access to a quiet, distraction-free workspace and reliable high-speed internet to maintain. The company will provide necessary equipment and technical support, as applicable.
  • All employees must be able to work in environments that comply with HIPAA privacy and confidentiality standards and must ensure the protection of sensitive data.
  • Requires long periods of sitting and frequent use of a computer, including tasks involving data entry, document review, virtual meetings, and other digital tools.
  • Frequent verbal and written communication is expected. Employees must be able to talk, hear, and view screen-based communications clearly for extended periods.
  • This position is primarily sedentary but may occasionally require light physical activity such as moving within a workspace, retrieving files, or carrying office equipment weighing up to 15 pounds.
  • Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of this job.
  
  
  Salary Description
  
  $22 to $25 per hour

• About the company

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