WCM/CCM EC/Precert Specialist

Job Description
Required Skills and Experience:
Medical Terminology or medical background such as nursing assistant/tech or doctor office experience Customer Service experience
Exceptional phone skills
Administrative/PC skills

Highly preferred:
- Triage and resolve inquiries via calls, voicemail messages, electronic systems, or faxes, that are
received from internal and external stakeholders for precertification and appeals.
- Refer and/or warm transfer to wellness and care management components and other BCBSM areas and vendors as needed

1.. Perform non-clinical authorizations and letter generation according to the department guidelines.
2. Evaluate and identify clinical requests that require medical necessity review and route to
appropriate clinical staff.
3. 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.

Ability to function independently.
Critical Thinking
Quick learner

EDUCATION AND/OR EXPERIENCE
1. Two (2) years of college is preferred.
2. Experience with benefits and procedures as related to assigned
department.
3. Three (3) to five (5) years of experience in the healthcare industry preferred.
About Kyyba:                                                                                                    
Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.
At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development. 
Disclaimer: 
Kyyba is an Equal Opportunity Employer.
Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. Minorities / Females / Protected Veterans / Individuals with Disabilities are encouraged to apply. All employment is decided on the basis of qualifications, merit, and business need.
Rewards:
Medical, dental, vision
401k 
Term life
Voluntary life and disability insurance
Optional Pre-paid legal plan
Optional Identity theft plan
Optional Medical and dependent FSA
Work-visa sponsorship
Opportunity for advancement
Long-term assignment with opportunity for hire by client 
 
SELECT AWARDS

• An INC 5000 company for 10 years
• Corp! Michigan Economic Bright Spots 
• Crain’s Detroit Business Top Staffing Service Companies in Detroit
• TechServe Alliance Excellence Award- IT and Engineering Staffing & Solutions
• Best of MichBusiness winner in HR Wizards & Partnerships
• Metro Detroit Elite Category: Recruitment, Selection & Orientation for 101 Best & Brightest
• 101 Best & Brightest Companies to Work for in Michigan