Pre-Certification Coordinator II - Pediatric Endocrinology
About The Position
This position performs prior-authorization services to ensure medical/surgical and diagnostic/ancillary services are accomplished in an efficient manner and that reimbursement is maximized through required interaction with payers. The primary duties include initiating and facilitating the prior authorization process, contacting appropriate insurance companies for benefit verification and pre-certification of surgical and non-surgical procedures, outpatient testing, and medications. This role also notifies the financial counselor for pre-payment of un-coded services, supplies all necessary documentation for the pre-certification process to insurance companies, maintains a written log of all pre-certifications in process, and notifies the hospital utilization/billing department of pre-certification status. The position also documents when pre-certification is received from insurance companies and performs other duties as assigned.
Requirements
- High school diploma or equivalent high school certification or combination of education and/or experience.
- 3 Years of experience in Clinical Office, Medical Billing, Health Information Management (HIM), or Pre-Certification.
- No specific certification/professional license is required for this position.
- A driver's license is not required for this position.
Nice To Haves
- Associate degree
- Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)
- Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)
- Communication skills
- Detail-Oriented skills
- Epic EHR experience
- Experience in Fast-Paced Environments
- Knowledge of Health Insurance Portability & Accountability Act (HIPAA)
- Experience with Insurance Claim Processing Software
- Experience with Insurance Precertification
- Knowledge of Insurance Terminology
- Interpersonal Communication skills
- Experience with Medical Coding Software
- Multitasking skills
- Organizational Savvy
- Prioritization skills
Responsibilities
- Initiates and facilitates prior authorization process.
- Contacts appropriate insurance companies for benefit verification and pre-certification of surgical and non-surgical procedures, outpatient testing, and medications.
- Notifies financial counselor for pre-payment of un-coded services.
- Supplies all documentation required during pre-certification process to insurance companies.
- Maintains written log of all pre-certifications in process.
- Notifies hospital utilization/billing department of pre-certification.
- Documents when pre-certification is received from insurance companies.
- Performs other duties as assigned.
Benefits
- Up to 22 days of vacation
- 10 recognized holidays
- Sick time
- Competitive health insurance packages with priority appointments and lower copays/coinsurance
- Free Metro transit U-Pass for eligible employees
- 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
- 4 weeks of caregiver leave to bond with your new child
- Family care resources for continued childcare needs
- Adult care resources
- Tuition coverage for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years of employment
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
