Prior Authorization / Pre-Certification Specialist

WHO ARE WE?

Indiana Spine Group is a growing physician owned specialty practice with multiple locations in central Indiana. We are committed to providing excellent care for our patients and in turn understand the importance of providing the same to our employees. Team work is emphasized as well as each employee’s responsibility for individual work load.

ROLE OVERVIEW:

Prior Auth/Pre-Cert Specialist oversees the process of obtaining Prior Authorizations. This process includes collecting all necessary documentation, contacting facilities, physician and/or staff for additional information. May also involve communication with a member or patient. Ability to quickly determine whether the order is likely to be approved based on documentation and submitting the request via online portal or over the phone to insurance. This position may also be responsible for obtaining cost estimates, for the necessary approvals to be made.

QUALIFICATIONS

• High School graduate or GED equivalent
• Minimum of 2 years of experience in Medical or Insurance field
• Medical billing/coding knowledge required

ESSENTIAL DUTIES:

The following list describes the essential duties of this role. Individuals in this role may not perform all of these duties, or may perform additional or unrelated duties

• Verify patient eligibility and review benefits
• Verify all codes are reviewable benefits
• Review codes and submit Prior Authorization request
• Review and submit clinicals documentations
• Follow through with obtaining the Prior Authorization
• Coordinate Peer-to-Peer review when needed
• Submit Appeals
• Collect pre-payments when applicable
• Submit retro-authorizations when applicable
• Meets department production standards consistently as defined by the department management
• Perform all duties respectful of confidentiality and safety of all patients, employees, and providers
• Requires working knowledge of HIPAA Privacy Rules compliance

MINIMUM QUALIFICATIONS:

• Excellent verbal and written communication skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Strong analytical and problem-solving skills
• Ability to prioritize tasks and to delegate them when appropriate
• Ability to function well in a high-paced and at times stressful environment
• Gets along well with others and can work with peers in a team situation

Hybrid position after obtaining required training in office.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Work Location: Hybrid remote in Carmel, IN 46032