Precertification Specialist

About IHTC

At the Indiana Hemophilia & Thrombosis Center (IHTC), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic disorders, and to their families.

What You Will Do

As a Precertification Specialist, you will be responsible for verifying patient eligibility with payers and works in conjunction with the front office staff, billing department, and providers to coordinate referrals, precertification’s, or prior authorizations for medications and clinical services such as procedures and laboratory testing.

The Opportunity

• Secure appropriate medical documentation requested by third-party insurance providers.
• Verify insurance coverage for physician or clinical services.
• Prior to expected date of service, prepare and submit precertification and prior authorizations to physicians, hospitals, and third-party payers.  Follow up with patients, physicians, and hospitals regarding denials, working with providers and staff to resubmit paperwork to obtain an approval.
• Notify patients, providers, and front office staff prior to date of service if referrals, precertification, or prior authorizations are not approved. Facilitate appointment rescheduling as necessary and ensure correct reporting of patient diagnosis and procedures.
• Field working requests from CoverMyMeds for additional information needed to process outpatient claims and submit corrections/information accordingly.
• Remain up-to-date on outpatient billing and benefit changes for third-party insurance carriers.  Maintain compliance with all government and non-government insurance company policies and procedures as they relate to outpatient services.
• Assist as need with EMR special project teams in development of electronic creation and tracking of referral forms.
• Ensure correct reporting of patient diagnosis and procedure coding.
• Work with clinic PA Nurse in creation of LOM and scheduling of peer to peer reviews as necessary.
• Ensure compliance with LCS/NDC’s are adhered to as needed. Communicate findings to providers/fellow team members, and billing manger as needed. 

Requirements

• High school diploma or GED
• Minimum 1 year of related experience
• Valid Indiana Driver’s license and automobile insurance

Benefits

Why join our team? 

The IHTC is a not-for-profit program based in Indianapolis and offers a competitive salary and benefit package. 

The IHTC is the only federally designated comprehensive hemophilia program in Indiana and serves the entire state through services available in Indianapolis and at outreach clinics. 

The IHTC is a leader in hemophilia care, education and clinical research and has a dedicated on-site multidisciplinary staff to ensure availability of a wide range of required services. 

The IHTC participates in national and international clinical research, including new infusion products and therapies, investigation of long-term outcomes, and the impact of associated conditions. The IHTC research program provides patients access to new therapies, and an opportunity to improve care. Our center has more than 50 clinical research projects involving bleeding disorders, sickle cell disease, thrombosis and more. 

The Indiana Hemophilia and Thrombosis Center is an Equal Opportunity Employer.