Blue Cross Blue Shield of Michigan Specialist - MA Inpatient Precertification - MA 00 in Detroit, Michigan
Under general supervision, responsible for providing non-clinical experience-based support and assistance to management, nursing staff, physician staff, support staff, and internal and external customers. Responsible for receiving and responding to calls and other types of inbound requests from external customers and preparation of routine assignments.Triage and resolve inquiries via calls, voicemail messages, electronic systems, or faxes, that are received from internal and external stakeholders for precertification and appeals.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.Create and prepare reports as assigned.Assist in the training and precepting of new employees in assigned area.Assist in other projects and duties as assigned."Qualifications"High School Graduate or GED equivalent required. Two (2) years of college is preferred.Three (3) to five (5) years of experience with benefits and procedures as related to assigned department.Three (3) to five (5) years of experience in the healthcare industry preferred.Working knowledge of personal computers.Analytical and problem-solving skills.Knowledge of medical terminology.Telephonic customer service experience preferred.Excellent verbal and written communication skills.Other related skills and/or abilities may be required to perform this job.All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.Equal Opportunity Employerndash;minorities/females/veterans/individuals with disabilities/sexual orientation/gender identityPlease see job description for required skills.