[Hiring] Precertification Specialist I @Innovative Care Management, Inc.

Role Description

The Precertification Specialist I is a customer-service-focused role that serves as a primary telephone contact for physician offices, hospitals, patients, and other callers seeking assistance with precertification services. In this role, you’ll spend much of your day helping callers understand where their request stands, connecting them with the right resources, documenting important information, and making sure questions and follow-up needs reach the appropriate team members.

This is a great fit for someone who enjoys helping people, communicates clearly, stays organized in a fast-paced environment, and can remain calm and professional during difficult or sensitive conversations. Candidates must reside in Oregon. This is a fully remote position requiring a quiet, distraction-free workspace and reliable high-speed internet.

Schedule: Monday–Friday

Shift will be either 7:00 AM - 4:00 PM or 8:00 AM–5:00 PM Pacific Time.

Qualifications

• At least one year of experience in a call center, contact center, or other telephone-based customer service role.
• Strong communication and active-listening skills, with the ability to remain patient, professional, and empathetic during challenging conversations.
• Comfort handling a steady volume of calls while navigating multiple computer systems and documenting information accurately.
• Strong attention to detail and the ability to follow established processes and procedures.
• Good judgment and the ability to recognize when a question should be referred or escalated.
• Dependability, punctuality, and the ability to work independently in a remote environment while remaining available during scheduled hours.
• Comfort learning new technology, systems, and workflows.
• Strong problem-solving skills and a willingness to ask questions, learn, and respond to feedback.
• The ability to handle confidential information appropriately and protect patient and member privacy.
• A high school diploma or GED.
• Healthcare experience is helpful, but not required.
• Experience in a medical office, health insurance, third-party administrator, patient services, or healthcare call center environment would be a plus.
• Familiarity with medical terminology, prior authorization or precertification processes, call queue systems, or remote customer service is also helpful.
• Bilingual communication skills are a plus.

Requirements

• Answer a high volume of inbound calls from physician offices, hospitals, patients, and other callers with professionalism, empathy, and excellent customer service.
• Remain available in assigned phone and voicemail queues throughout scheduled working hours, excluding approved breaks, meal periods, and other authorized activities.
• Listen actively, clarify the purpose of each call, and provide accurate information within established precertification procedures and the scope of the role.
• Communicate precertification status information and approval numbers when available and approved for release.
• Verify precertification requirements and identify requests that need additional processing or entry by another team member.
• Route incoming calls, callback requests, messages, and precertification-related needs promptly to the appropriate team or resource.
• Refer benefit-related inquiries to the appropriate claims administrator or benefits department.
• Transfer or escalate clinical, complex, unusual, or out-of-scope questions appropriately.
• Handle difficult or sensitive conversations calmly and professionally while providing clear guidance on next steps.
• Accurately document call details, messages, actions taken, and follow-up needs in approved systems.
• Communicate relevant caller information clearly and promptly to teammates to help prevent missed follow-up or service delays.
• Maintain objective, complete, and factual documentation without including assumptions, personal opinions, or subjective interpretations.
• Follow established expectations for call handling, quality, availability, productivity, and escalation.
• Maintain the privacy and security of patient and member information in accordance with HIPAA and company policies.
• Follow approved verification and communication procedures before releasing protected or sensitive information.
• Complete assigned outbound calls and other telephone-based customer service responsibilities as needed.

Company Description