Pre-Certification Coordinator II (Remote) - Department of Medicine - Business Office

Washington University in St. Louis

3d • $23 - $34 • Remote

About The Position

This advanced level Pre-certification Coordinator specializes in complex pre-certifications for high dollar oncology and/or non-oncology drugs as indicated on therapy and treatment plans to prevent controllable losses/write offs for the department. This position may also perform re-checks of insurance eligibility and verify authorization information for each service. This position will also document all pertinent authorization information in Epic and communicate with clinical staff and providers in a timely and effective manner.

Requirements

• High school diploma or equivalent high school certification or combination of education and/or experience.
• Clinical Office, Medical Billing, Health Information Management (Him), Or Pre-Certification (3 Years)

Nice To Haves

• Coding experience and previous pre-certification experience.
• Applicant must have a thorough understanding of both WashU insurance database and insurance terminology.
• Experience interacting with managed care plans, insurance companies and third-party payers.
• Ability to work with internal and external customers, including physicians, nurses, patients and families.
• Associate degree
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)
• Communication, Detail-Oriented, Epic EHR, External Customers, Family Communication, Fast-Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), Insurance Claim Processing Software, Insurance Precertification, Insurance Terminology, Interact with All Levels of Management, Internal Customers, Interpersonal Communication, Managed Care, Medical Coding Software, Multitasking, Organizational Savvy, Patient Interactions, Prioritization, Third Party Payers

Responsibilities

• Completes pre-certifications for complex and high dollar drugs as indicated on therapy and treatment plans. Must read and analyze therapy and treatment plans, drug protocols and clinical documentation, as well as payer policies and patient benefits.
• Completes the authorization process with the payer and in EPIC.
• Completes re-checks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all re-check information is documented in EPIC.
• Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution in a timely fashion.
• Other duties as assigned, such as assistance with denials, rejections and appeals.

Benefits

• Up to 22 days of vacation, 10 recognized holidays, and sick time.
• Competitive health insurance packages with priority appointments and lower copays/coinsurance.
• Take advantage of our free Metro transit U-Pass for eligible employees.
• WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.
• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!
• We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered.
• WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED