Utilization Review & Precertification Specialist

The Indiana Hemophilia & Thrombosis Center; Indianapolis (IN); On-site; USD 45,000 - 65,000; Full time

Job summary

The Indiana Hemophilia & Thrombosis Center in Indianapolis is seeking a Utilization Review Specialist to verify patient eligibility with payers and coordinate precertifications and prior authorizations for medications, in collaboration with pharmacy staff and providers.

You will stay up to date on outpatient billing, ensure accurate coding, and communicate denials and required documentation, helping secure timely access to essential therapies.

Qualifications

• Proficiency in clinical/administrative software systems.
• Strong understanding of billing practices and clinic policies.
• Ability to read and interpret medical charts and documentation.

Responsibilities

• Verify patient eligibility with payers and coordinate referrals, precertification, or prior authorizations with pharmacy staff and providers.
• Prepare and submit precertification and prior authorizations to payers; follow up on denials with patients, pharmacies and physicians.
• Notify patients, providers and front office staff before the date of service if approvals are not obtained.
• Maintain compliance with LCD/NCDs and report any medical necessity issues to the team.
• Prepare and submit pharmacy claims to third-party carriers; verify coverage prior to services.
• Follow up on unpaid claims or balances with payers; document steps taken in billing systems.
• Research payer regulations and claim guidelines to ensure compliant submission.

Skills

Clinical software proficiency

Education

High school diploma or GED

Job description

The Indiana Hemophilia & Thrombosis Center in Indianapolis is seeking a Utilization Review Specialist to verify patient eligibility with payers and coordinate precertifications and prior authorizations for medications, in collaboration with pharmacy staff and providers.

You will stay up to date on outpatient billing, ensure accurate coding, and communicate denials and required documentation, helping secure timely access to essential therapies.