Pre-Cert Operations Manager (Remote)

OneOncology; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

OneOncology is seeking a Manager, Pre‑Certification to oversee the Pre‑Cert team, ensuring eligibility, benefits verification, and patient estimates are handled efficiently and accurately. You will collaborate with vendor partners and internal teams to minimize disruptions in patient care and revenue.

The role requires leadership, detail orientation, and strong knowledge of medical terminology, ICD, and CPT codes, with remote work experience highly preferred.

Qualifications

• Minimum High School Diploma or GED required.
• Minimum of five (5) years Pre-Certification, Medical Front Office, or Medical Billing experience.
• Experience working from home or in a remote capacity is highly preferred.

Responsibilities

• Oversee the daily Pre-Cert schedule to ensure the vendor partner and Pre‑Cert team are completing eligibility and benefits tasks, obtaining Pre‑Certs/referrals, and generating patient estimates.
• Ensure all cases comply with payer policy.
• Manage daily workload to balance distribution between vendor partner and internal coordinators for timely work.
• Act as lead contact with vendor partner and collaborate on cases at risk to avoid care disruptions or revenue loss.
• Audit completed cases to ensure proper procedures are followed.
• Address issues related to incorrect patient estimates.
• Coordinate with Accounts Receivable on denials related to Pre‑Cert cases.
• Prepare and update training materials; inform vendor of new payer or procedure requirements.
• Work with provider staff on at-risk cases and determine steps to avoid disruptions or revenue loss.
• Maintain knowledge of payer policy, clinical criteria, and Pre‑Cert requirements.
• Focus on process improvements to maximize efficiency and quality of Pre‑Cert work.
• Participate in new procedure workflows and create training materials to support processes.
• Other duties supporting our mission to improve lives of cancer patients.

Skills

Customer service

Leadership

Time management

Communication

Attention to detail

Medical terminology

ICD/CPT knowledge

Computer skills

Remote work capability

Typing speed 40 wpm

Attendance

Problem-solving

Education

High School Diploma or GED

Job description

OneOncology is seeking a Manager, Pre‑Certification to oversee the Pre‑Cert team, ensuring eligibility, benefits verification, and patient estimates are handled efficiently and accurately. You will collaborate with vendor partners and internal teams to minimize disruptions in patient care and revenue.

The role requires leadership, detail orientation, and strong knowledge of medical terminology, ICD, and CPT codes, with remote work experience highly preferred.