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

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

• Some college or associate's degree
• RHIT and/or CPC certification
• coding experience and previous precertification experience.
• Thorough understanding of both WashU insurance database and insurance terminology.
• Excellent communication, interpersonal and organizational skills requires
• 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.
• Ability to prioritize multiple tasks, be detail oriented and able to work in a fast paced environment.
• 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 specialized services as indicated on therapy and treatment plans.
• Reads and analyzes 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.
• Performs 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