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This position will hold Normal Business hours Monday- Friday 8:30 - 5p.m.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.Essential Duties and 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

Qualifications: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

COVID POLICY: This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsiteFor this position, we anticipate offering an hourly rate of $17 - $25, depending on relevant factors, including experience and geographic location.This role is also anticipated to be eligible to participate in an annual bonus plan.Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our careersite: www.cigna.com/careersAbout CignaCigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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