Pre-Certification Manager - Urology

OneOncology; United States; Remote; USD 65,000 - 98,000; Full time

Job summary

OneOncology seeks a Manager, Pre-Certification to oversee the Pre-Cert team operations, ensuring timely eligibility verification, pre-cert and referrals, and accurate patient estimates. You will coordinate with vendor partners, monitor daily schedules, and audit cases for payer policy compliance to prevent care disruption and revenue loss.

As a leader, you will train staff, develop materials, stay current on payer requirements, and drive process improvements while supporting remote work and

Qualifications

• Minimum five (5) years Pre-Certification, Medical Front Office, or Medical Billing experience.
• Experience working from home or in a remote capacity is highly preferred.
• Strong customer service and leadership abilities.

Responsibilities

• Oversee daily Pre-Cert schedule with vendor partner and team for eligibility, benefits, Pre-Cert, and patient estimates.
• Ensure cases comply with payer policy and are completed timely and accurately.
• Manage workload distribution between vendor partner and Pre-Cert Coordinators.
• Lead point of contact with vendor partner and resolve cases at risk to avoid care disruption or revenue loss.
• Audit completed cases for proper procedures and correct patient estimates.
• Collaborate with Accounts Receivable on denials related to Pre-Cert cases.
• Develop training materials and update vendor on payer/procedure changes.
• Support remote staff and coordinate with provider offices to prevent disruptions.
• Continuously improve processes to enhance efficiency and quality.

Skills

Leadership

Communication

Time management

Attention to detail

Remote work

Medical terminology

Typing 40 WPM

Education

High School Diploma or GED

Tools

Medical billing software

ICD/CPT knowledge

Job description

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

Role Summary:

The Manager, Pre-Certification (Pre-Cert) is responsible for overseeing the entire operation of the Pre-Cert team, which is responsible for verifying patient eligibility and benefits, obtaining a pre-cert and/or referral, and patient estimate for procedures.

Responsibilities:

• Oversee the daily Pre-Cert schedule to ensure the vendor partner and Pre-Cert team are completing the eligibility and benefits, obtaining a Pre-Cert and/or referral, and generating patient estimates in a timely and accurate fashion.
• Ensure that all cases are completed in compliance with payer policy.
• Manage the daily workload to ensure cases are worked timely and accurately, and the distribution between the vendor partner and the UUG Pre-Cert Coordinators is appropriate.
• Acts as the lead point of contact with the vendor partner and collaborates on any outstanding cases or cases at risk to avoid patient care disruptions or revenue loss.
• Audits completed cases to ensure proper procedures are followed.
• Addresses any issues relating to incorrect patient estimates.
• Partners with the Accounts Receivable team on any denials for no Pre-Cert or referral related to cases for which the Pre-Cert team is responsible.
• Prepares and updates materials in training manual and updates the vendor partner on any new payer or procedure requirements.
• Works directly with the provider's staff on any cases that are at risk and determines the appropriate steps to avoid patient care disruption or lost revenue.
• Maintains personal and team knowledge of payer policy, clinical criteria, and Pre-Cert requirements.
• Focuses on process improvement to maximize the efficiency and quality of Pre-Cert team.
• Participates in new procedure workflow development and creates training materials to support the process.
• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

Required or 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.

Essential Competencies:

• Excellent customer service skills.
• Superior leadership, problem-solving, team building, and decision-making skills.
• Ability to effectively manage tasks and meet deadlines while working independently.
• Excellent written, verbal, and interpersonal communication skills, especially in a virtual work environment.
• Attention to detail and willingness to learn and apply constructive feedback.
• Proficient knowledge of Medical Terminology, ICD, and CPT Codes.
• Proficient computer software and database skills.
• Strong attention to detail.
• Ability to deliver high-quality results and achieve goals while working remotely.
• Collection background is a plus.
• Urology background is a plus.
• Ability to type a minimum of 40 words per minute.
• Attendance is an essential job function.

This job description does not contain a full listing of activities, duties or responsibilities required of this role. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.