Pre-Certification Coordinator II (Remote) - Orthopedic Surgery

Washington University in St. Louis; Deutschland; Remote; EUR 28.000 - 42.000; Vollzeit

Benefits dieser Stelle

Remote work

Zusammenfassung

Washington University in St. Louis seeks an experienced Pre-Certification Specialist to handle complex service pre-authorizations. You will read therapy plans, verify payer policies, and document all authorizations in EPIC while coordinating with clinical staff for timely resolutions.

The role requires 3 years in medical billing or pre-certification, familiarity with EPIC, and strong attention to detail. Remote US-based position offering competitive benefits.

Qualifikationen

• Education: High school diploma or equivalent.
• Certifications: CPC and RHIT preferred but not required.
• Work Experience: 3 years in Clinical Office, Medical Billing or Pre-Certification.
• Skills: Not Applicable

Aufgaben

• Completes pre-certifications for complex services per therapy plans.
• Verifies insurance eligibility and payer information in EPIC.
• Coordinates with clinical staff to resolve add-ons and denials.
• Documents authorization details and communicates with providers.

Kenntnisse

Communication

Detail-Oriented

Epic EHR

HIPAA

Interpersonal Communication

Organizational Savvy

Multitasking

Ausbildung

High school diploma

Associate degree

Certified Professional Coder (CPC)

RHIT - AHIMA

Tools

Epic EHR

Insurance Claim Processing Software

Jobbeschreibung

Location

Remote, US

Scheduled Hours

40

Position Summary

Advanced level specialization in complex pre-certifications as indicated on therapy and treatment plans to prevent controllable losses/write offs for the Department. May perform rechecks of insurance eligibility and verify authorization information for each service. Documents all pertinent authorization information in EPIC and communicates with clinical staff and providers in a timely and effective manner.

Job Description

Primary Duties & 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 rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all recheck 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.

Working Conditions

Job Location/Working Conditions

Normal office environment

Physical Effort

Typically sitting at desk or table

Equipment

Office equipment

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications

Education:
High school diploma or equivalent high school certification or combination of education and/or experience.

Certifications /Professional Licenses :
No specific certification/professional license is required for this position.

Work Experience:
Clinical Office, Medical Billing, Health Information Management (Him), Or Pre-Certification (3 Years)

Skills:
Not Applicable

Driver's License:
A driver's license is not required for this position.

Preferred Qualifications

Education:
Associate degree

Certifications /Professional Licenses :
Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Work Experience:
No additional work experience unless stated elsewhere in the job posting.

Skills:
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

Grade

C09-H

Salary Range

$23.63 - $35.49 / Hourly

The salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.

Questions

For frequently asked questions about the application process, please refer to our External Applicant FAQ .

Accommodation

If you are unable to use our online application system and would like an accommodation, please email [e-mail] or call the dedicated accommodation inquiry number at 314-935-1149 and leave a voicemail with the nature of your request.

All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.

Pre-Employment Screening

All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.

Benefits Statement

Personal

Up to 22 days of vacation, 10 recognized holidays, and sick time.

Competitive health insurance packages with priority appointments and lower copays/coinsurance.

More About This Job

WashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles.