Pharmacy Pre Certification specialist

Job Title: Pharmacy Billing and Prior Authorization Specialist

Location: Indianapolis, IN (100% remote after in office training)

Schedule: M-F 8a-5p

Duration/Type: Direct Hire

Job Overview:

LHH Recruitment Solutions has partnered with a healthcare organization seeking a Pre-Certification Specialist. This position is based in Indianapolis, IN and will be 100% remote after onsite training. This position is responsible for verifying patient eligibility with payers and works with the pharmacy staff to coordinate referrals, precertification, or prior authorizations for medications. This is a Direct Hire opportunity.

Responsibilities:

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  Obtain medical documentation requested by third-party insurance providers.

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  Verify insurance coverage for pharmacy benefits.

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  Prepare and submit precertification and prior authorizations to physicians’ hospitals and third party payers.

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  Follow up with patients’ insurance companies, pharmacy staff, and physicians regarding denials working with providers and staff to resubmit paperwork to obtain an approval.

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  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.

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  outpatient billing and benefit changes for third-party insurance carriers.

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  compliance with all government and non-government insurance company policies and procedures as they relate to outpatient services.

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  Ensure correct reporting of patient diagnosis and procedure coding.

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  Prepare and submit pharmacy claims to third party insurance carriers.

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  Follow up with third party insurance carriers and patients on unpaid claims or balances.

Qualifications:

· High School Diploma or GED required.

· 1 year of related experience required.

· Knowledge of billing practices and clinic policies and procedures

· Knowledge of coding and clinic operating policies

· Proficient computer skills

· Ability to read and interpret medical charts.

· Ability to examine documents.

· Strong communication skills

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our program provides employees with the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.

Pay Details: $21.00 to $23.50 per hour Search managed by: Marisa Marques

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.