Pharmacy Precertification Specialist

3 weeks ago

Indianapolis, United States Indiana Hemophilia & Thrombosis Center, Inc. Full time
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 Pharmacy Precertification Specialist, you will be responsible for verifying patient eligibility with payers and works in conjunction with the pharmacy staff and providers to coordinate referrals, precertification, or prior authorizations for medications.

The Opportunity

  • Secure appropriate medical documentation requested by third-party insurance providers
  • Verify insurance coverage for pharmacy benefits.
  • Prior to expected date of service, prepare and submit precertification and prior authorizations to physicians, hospitals, and third party payers. Follow up with patients, insurance companies, pharmacy staff, and physicians 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
  • 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
  • Ensure correct reporting of patient diagnosis and procedure coding
  • Ensure compliance with LCS/NDC's are adhered to as needed. Communicate findings to providers/fellow team members, and billing manger as needed
  • Prepare and submit pharmacy claims to third party insurance carriers
  • Secure appropriate medical documentation as required by third party insurance carriers
  • Follow up with third party insurance carriers and patients on unpaid claims or balances
  • Research payer regulations and claim guidelines on payment and claim submission criteria to ensure compliant billing practices by utilizing website and associated tools established for payers as applicable
  • Verify insurance coverage for pharmacy services prior to services being rendered
  • Ensure accurate and thorough documentation of steps taken to resolve claim issues are recorded in billing software(s)
  • Monitor claims for accuracy and authorization. Communicate claim issues to team lead and/or billing manager on a regular basis
  • Work with team lead/manager to establish weekly, monthly and annual goals and communicate associated progress as needed

Requirements

  • High school diploma or GED
  • Minimum 3 years 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.

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