Precert Analyst at Blue Cross Blue Shield Kansas in Wichita, Kansas

Job Description:

With the support of the precert coordinator, the precert analyst is responsible for initial intake, benefit verification, and triage of requests from various sources for precertification, concurrent review, case management, and alternative care services for all Blue Cross and Blue Shield of Kansas products. The precert analyst is responsible for requesting and/or obtaining additional information to enter documentation of requests into various corporate systems (i.e. precert, case management, online tracking inquiry system (OTIS), etc.


"This position must complete a required onsite training. Upon completion of the initial six-month training period, this position will be eligible for remote or hybrid (a minimum of 9 days per month onsite) work option, in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."



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Why Join Us?

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  Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  
  


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  Family Comes First: Total rewards package that promotes the idea of family first for all employees.
  
  


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  Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  
  


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  Stability: 80 years of commitment, compassion and community
  
  


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  Flexibility: options to work onsite, hybrid or remote available
  
  


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  Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  
  


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  Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
  
  

Compensation



$20.42 - 24.30 hourly
Non-Exempt 11

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
  
  

What you'll do

• Responsible for performing all job functions in compliance with HIPAA, URAC Health Plan/utilization management (UM)/case management (CM) requirements, Corporate and/or other guidelines or regulations governing area activities
  
  


• Responsible for taking incoming calls via the precert toll-free number, determining the nature of the call, triaging it to the correct location, making follow-up calls to providers/internal staff as appropriate, and/or loading/documenting non-clinical information into the UM and/or appropriate system(s) to initiate or complete a request for service for inpatient or alternative level of care.
  
  


• Research and document in various corporate systems for member and/or provider information.
  
  


• Responsible for assisting with handling of department Right fax queue.
  
  


• Responsible for the pend/ incomplete workload first level and batch certification suspension activities to ensure review requests are completed within URAC HUM required timeframes.
  
  


• Responsible for updating service requests loaded as an eligibility override (via the workload) as information becomes available in EIM or membership eligibility to support accurate and timely claims adjudication.
  
  


• Responsible for reviewing precert system data (live or via reports) for identification of potential large dollar cases. Gathers notification information to include contacting providers for charges to date, and consulting with other staff, if needed, to get adequate information to complete the large dollar notification form. Send the completed form to the sales rep and actuarial staff in a timely manner.
  
  


• Responsible for maintaining current knowledge of precert processes, applicable health plan standards (URAC and State), DOL, and HIPAA requirements. Provides input for process improvements or changes as needed. Takes responsibility for learning new policies and guidelines, corporate and departmental, as established.
  
  


• Recognizes and accepts responsibility for own quality, production, attendance, punctuality, and attainment of department and corporate mission, vision, and goals.
  
  

What you need


Knowledge/Skills/Abilities

• Requires working knowledge of personal computers.
  
  


• Knowledge of provider file search functions, OTIS, CSI, Imaging/BlueCM, Outlook, and My Blue View systems preferred.
  
  


• Knowledge of precert, case management, knowledge management FEP Direct, provider reimbursement schedules and various internet applications preferred.
  
  


• Knowledge of EIM helpful.
  
  


• General knowledge of all product lines, contract, and related operating policies preferred.
  
  


• Excellent verbal and written communication skills required, with the ability to interact positively with all levels of internal staff and external customers.
  
  


• Excellent organizational skills and the ability to work independently are required in order to handles the heavy workload.
  
  

Education and Experience

• High School graduate or equivalent required.
  
  


• Minimum of two years of customer service experience preferred.
  
  


• Medical knowledge (Medical Assistant, Certified Nurse Aide, Medical Records, Medical Office Receptionist) , or one year previous medical review or claims processing experience preferred.
  
  

Physical Requirements

• Work is confining. Telephone and computer input activity consume 95% of the day.
  
  


• Must accurately complete various complex activities within assigned deadlines with minimal supervision and frequent interruptions.
  
  


• Must maintain an excellent record of attendance.
  
  

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package
  
  


• Incentive pay program (EPIP)
  
  


• Health/Vision/Dental insurance
  
  


• 6 weeks paid parental leave for new mothers and fathers
  
  


• Fertility/Adoption assistance
  
  


• 2 weeks paid caregiver leave
  
  


• 5% 401(k) plan matching
  
  


• Tuition reimbursement
  
  


• Health & fitness benefits, discounts and resources
  
  

Our Commitment to Diversity, Equity, Inclusion, and Belonging



At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.


We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all. Apply Now