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

Washington University in St. Louis; St. Louis (MO); Remote; USD 60,000 - 80,000; Full time

Job summary

Washington University in St. Louis seeks a Pre-Certification Coordinator II to manage complex pre-certifications for oncology and non-oncology drugs. This remote position requires prior experience in medical billing and patient insurance, emphasizing strong communication and organizational skills. The ideal candidate will work closely with clinical staff to ensure timely authorizations and care continuity.

Benefits

Competitive health insurance packages

Up to 22 days of vacation and recognized holidays

Defined contribution retirement savings plan

Free Metro transit U-Pass for eligible employees

Qualifications

• 3 years experience in Clinical Office, Medical Billing, or Pre-Certification experience required.
• Coding experience preferred; understanding of insurance terminology is essential.
• Preferred certifications: CPC, RHIT.

Responsibilities

• Complete pre-certifications for complex drugs based on therapy plans.
• Verify insurance eligibility and authorization for all applicable services.
• Facilitate resolution of add-ons, denials, and peer-to-peer interactions.

Skills

Communication

Detail-Oriented

Interpersonal Communication

Multitasking

Organizational Savvy

Prioritization

Education

High school diploma or equivalent

Associate degree (preferred)

Tools

Epic EHR

Job description

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

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

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Position Summary

Scheduled Hours

40

Position Summary

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 rechecks 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.

Job Description

Primary Duties & 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 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.
• 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.

Education:

Required Qualifications

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

Certifications:

No specific certification 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

More About This Job

• Coding experience and previous pre-certification experience preferred.
• Applicant must have a thorough understanding of both Washington University 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.
  
  

Education:

Preferred Qualifications

Associate degree

Certifications:

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 beyond what is stated in the Required Qualifications section.

Skills:

Communication, Detail-Oriented, Epic EHR, Fast-Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), Insurance Terminology, Interpersonal Communication, Multitasking, Organizational Savvy, Prioritization

Grade

C09-H

Salary Range

$22.78 - $34.21 / 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.
• 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

• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!
  
  

Family

• 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.
  
  

For policies, detailed benefits, and eligibility, please visit: https://hr.wustl.edu/benefits/

EEO Statement

Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. It is the University’s policy to provide equal opportunity and access to persons in all job titles without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.

Washington University is dedicated to building a community of individuals who are committed to contributing to an inclusive environment – fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  Higher Education

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