Clinical Services Specialist

Full-time Description Indiana Health Centers, Inc. (IHC) is a mission-driven organization providing high-quality, affordable healthcare to underserved and uninsured populations since 1977. At IHC, a Federally Qualified Health Center, we specialize in integrated care which means having access to essential services to meet the needs of patients we serve in the community. With ten healthcare centers, eight Women, Infants, and Children (WIC) nutrition program locations, a Mobile Health Unit, and in-house Pharmacy services (select locations), we offer primary medical, dental, and behavioral healthcare services to community-based patient populations throughout Indiana that are diverse in age, educational background, and income level. The IHC Corporate team is now recruiting for a remote Patient Service Center (PSC) Clinical Support Specialist living in the state of Indiana. The PSC Clinical Support Specialist is responsible for coordinating patient referrals and managing prior authorizations to ensure timely access to healthcare services. This role serves as a liaison between patients, providers, insurance companies, and specialty clinics to facilitate efficient care coordination. The specialist ensures all referrals and/or authorization documentation is complete, accurate, and compliant with payer requirements. Applicants who meet the following qualifications will receive priority consideration for this role: MA, LPN, or RN (required) Lives in the state of Indiana (required) Corporate Hours of Operation Monday - Friday, 8:00 am - 5:00 pm IHC’s robust benefits and compensation package includes: $1000.00 retention bonus paid after one year No nights or weekends Generous Paid Time Off and Floating Holidays Day 1 Insurance benefits eligibility 403(b) Retirement Plan matching at one year of employment Employer-paid Group Life, Short-term disability, and Long-term disability coverages and HSA employer contributions Flexible Leave of Absence programs Personify Health Wellness program with paid incentives for participation Employee Assistance Programs with 24/7 access to therapy consultation services PSC Clinical Support Specialist role responsibilities include: Prepare and submit prior authorization of requests for procedures, medications, imaging, and specialty services. Collect and compile required clinical documentation to support authorization requests. Communicate with insurance companies to obtain approval, provide additional information, or resolve authorization issues. Monitor authorization status and follow up on pending requests to prevent delays in care. Document authorization numbers, approvals, denials, and expiration dates in the EHR. Process incoming and/or outgoing patient referrals to specialty providers, diagnostic services, and ancillary care. Verify referral/PA requirements based on insurance guidelines and payer policies. Coordinate with providers and specialists to schedule referred services. Track referral/PAs statuses to ensure completion of appointments and continuity of care. Communicate referral information and appointment instructions to patients. Assist in training new staff for the Patient Service Center. Sending and following up on referrals, completing Prior Authorizations (PA), Scheduling Diagnostic Imaging tests, and other patient care related paperwork. Processes appropriate patient paperwork in a timely manner. Educate patients regarding documents they will need to provide at the time of service. Accurately enters, maintains, and retrieves data on IHC’s Electronic Medical Records (EMR) system. Communicates appropriate diagnostic and clinical information with patients as needed. Communicates with patients care team as necessary. May assist with contacting patients for reminder calls and follow-up. Required Skills: Great communication skills, both verbal and written. Knowledge of ICD-10 codes and meanings. Learn and follow standard work practices/procedures – every time – without variation or error. Follow established routines, requiring occasional modifications in procedure. Train others on referrals and prior authorizations functions and standard workflow Recognize, troubleshoot, and/or alert others to potential scheduling conflicts or problems. Speak professionally over the phone. Demonstrate office equipment and computer skills, including data entry. Able to use Microsoft Word, Excel, and Outlook, eCW, Dialpad, etc. Requirements PSC Clinical Support Specialist is required to be a Medical Assistant (must have completed Medical Assisting degree or certificate program), LPN, or RN (valid Indiana licenses in good standing). Lives in the state of Indiana (required) Knowledge and experience with both Medication and Imaging Prior Authorizations. Experience with referrals to specialists. Document management experience. One (1) year of prior experience in an office or health-related position preferred. Related education can substitute for experience. Knowledge of insurance verification and payer authorization processes preferred. Equal Opportunity Employment Statement We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.