Precertification Specialist

Who We Are

We've been treating pain effectively through minimally invasive techniques since 1992. At American Pain Consortium (APC), our mission is to empower our providers, including board-certified pain management physicians, with exceptional patient care. We are driven to deliver a national platform for like-minded interventional pain providers seeking to help patients find symptom relief and lead a better quality of life. We invest in the people, processes, systems, credentials, and facilities that consistently yield exceptional medical, operational, and financial outcomes. Our footprint includes clinic and ambulatory surgery centers throughout Indiana and Ohio.

As an employer, we help our team to reach their maximum professional potential and create an environment conducive to our shared success. Our "why" centers around our 7 inspirations: the pursuit of excellence, empathy in everything we do, a culture of collaboration, open communication, creating a space for belonging, and ongoing innovation, which yields the result of bringing value. APC is seeking an individual who is eager to learn, develop, and grow in a role in the Pre-Service Department located in the Support Office in Carmel, IN.

What do we do?

Our goal at American Pain Consortium is to support our clinics that help patients seeking relief from pain, numbness, and tingling sensations that are often related to neuropathic pain or neuropathy, among many other forms of chronic pain. Even patients who have tried other pain treatments without success often benefit significantly from safe, effective treatment at American Pain Consortium. Our clinical multidisciplinary approach to care delivers the correct intervention to every patient, every time through various pain management procedures including injections, open surgical cases with general anesthesia, physical therapy, and psychological services. Our Providers focus on helping individuals improve functionality to restore a more meaningful lifestyle.

APC values individuals with a strong work-ethic, embracing why they want to serve in the healthcare industry while maintaining a work, family, and life balance. APC is seeking an individual who is eager to learn, develop, and grow and help us contribute to our overall mission to empower Providers to deliver exceptional patient care.

Job Summary

The Pre-certification Specialist is responsible for obtaining insurance pre-certification prior to the rendering of medical services. This includes obtaining accurate demographic information, validating insurance information including eligibility, medical policy, and benefits as needed. Answers and provides resolution for any questions received from patients, providers, visitors, and staff.

Essential Duties & Responsibilities (What You'll Do)

• Secures insurance pre-certifications and prior authorizations for all scheduled services and procedures, ensuring accuracy, compliance with payer requirements, and timely completion to prevent delays in care.
• Thoroughly documents all critical authorization details in the designated system(s) to facilitate clean claims and reduce denials, ensuring alignment with billing and reimbursement protocols.
• Validates completeness and accuracy of submitted documentation, including but not limited to patient status, CPT and ICD-10 codes, rendering provider, and site of service. Coordinates with clinical and administrative staff to obtain missing or corrected documentation to support medical necessity.
• Audits scheduled procedures against physician orders to confirm consistency and compliance with payer guidelines, proactively addressing discrepancies to avoid delays or denials.
• Communicates authorization denials or downgrades to patients, providers, and internal stakeholders in a clear and timely manner, providing education or escalation as needed.
• Executes pre-certification processes within defined timeframes, initiating work on orders either within 7 business days of receipt or at least 7 business days prior to the scheduled service, in alignment with payer-specific requirements.
• Maintains comprehensive and current knowledge of insurance carrier medical policies, authorization requirements, benefit limitations, and policy changes across all payers.
• Serves as a resource for patients, providers, and staff, addressing inquiries and resolving issues with professionalism and accuracy, escalating complex concerns appropriately.
• Adheres to departmental standards for authorization accuracy, ensuring that 100% of authorizations are verified via payer portals or direct contact prior to service and documented in the chart.
• Engages in ongoing process improvement initiatives, contributing feedback and participating in workflow optimization to enhance efficiency, reduce denials, and improve the patient experience.
• All other duties as assigned

Minimum Qualifications (What We Are Looking For)

• 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.
• Proficient with Microsoft Office Suite or related software.
• Solid understanding of healthcare terminology
• Able to distill patient financial information and present essential information in a clear and concise manner
• Self-directed and able to work independently
• Hands- on style with the desire and ability to command details.

Education and/or Experience Requirements

• High School Diploma
• Preferred Minimum of 24 months administrative experience in a medical facility, health insurance, or related area preferred
• Prior scheduling, pre-certification, and medical terminology required
• Knowledge of function and relations within a healthcare clinic environment required.
• Experience with Ohio Workers Comp (BWC) and Implantable Devices is preferred.

Competencies

To perform the job successfully, an individual should demonstrate the following, which is included, but not limited, to:

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Customer Service - Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.
• Respect for Others - Treats patients, physicians, and colleagues in a professional, respectful, compassionate manner
• Respect for Privacy - Handles all patient, company, and staff information in a confidential manner compliant with all state and federal regulations and the APC Code of Conduct.

Physical Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standing and/or walking 10% of time
• Sitting 90% of the time
• Occasional lifting, stooping, kneeling, crouching, and reaching

Supervisory Responsibilities

This position has no supervisory responsibilities

Benefits (Work Perks)

Included for all full-time positions

• Medical, Dental, and Vision Insurance
• Paid Time Off
• Paid Holidays
• Matching 401K plan
• Other

Equal Employment Opportunity

American Pain Consortium Management, its affiliates, and subsidiaries are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, protected veteran status, national origin, sexual orientation, gender identity or expression (including transgender status), genetic information or any other characteristic protected by applicable law.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending