Intake Care Senior Representative- Remote- Cigna Healthcare

Position Summary:

The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization.

The Pre-cert Specialist will communicate with internal and external providers regarding authorization status.

Core Responsibilities:


* Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal


* Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)


* Determine authorization requirements based on company policy, member benefit grid and provider status


* Review customer coverage and benefits


* Review authorization requests and make determinations on correct authorization process (i.e.

auto approve, refer to Utilization Management Nurse)


* Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.


* Professional demeanor and the ability to work effectively within a team or independently


* Flexible with the ability to shift priorities when required


* Maintains regular and acceptable attendance in accordance with Time Away From Work policy


* Ability to work evening, weekend and holiday shifts to support the UM Department


* Other duties as requested

MinimuQualifications:


* High School Diploma and preferred 1-2 years' experience in a managed care environment


* Proficient in medical terminology, CPT, HCPCS and ICD-10 coding


* Effective oral and written communication skills


* Strong customer orientation


* Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word


* Excellent typing skills

Knowledge, Skills, Abilities Required:


* Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer


* Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment


* Proficient knowledge of departmental policies and procedures


* Knowledge of Medicare Regulatory Requirements

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 17 - 25 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure.

That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health.

Starting on day one of your employment, you'll be offe...