Remote Pre-Certification Manager: Elevate Patient Access

Astera Cancer Care; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

OneOncology is seeking a Manager, Pre-Certification to oversee the Pre-Cert team and ensure timely eligibility checks, referrals, and patient estimates across cases.

You will collaborate with vendor partners, Accounts Receivable, and provider staff to minimize patient care disruptions and revenue loss while maintaining payer policy compliance and high service standards in a remote work setting. This role emphasizes leadership, process improvement, and training to support community physicians.

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.
• Proficient knowledge of Medical Terminology, ICD, and CPT Codes.

Responsibilities

• Oversee the daily Pre-Cert schedule to ensure timely eligibility and benefits processing, and generation of patient estimates.
• Ensure all cases comply with payer policy.
• Manage workload and distribution between vendor partner and Pre-Cert Coordinators.
• Lead communications with the vendor partner and resolve cases at risk to avoid care disruption or revenue loss.
• Audit completed cases for proper procedures and accuracy of patient estimates.
• Collaborate with Accounts Receivable on denials related to Pre-Cert cases.
• Maintain training materials and update vendor on payer or procedure changes.
• Work with provider staff on at-risk cases to prevent disruption or revenue loss.
• Maintain knowledge of payer policy, clinical criteria, and Pre-Cert requirements.
• Focus on process improvements to maximize efficiency and quality.

Skills

Excellent customer service skills

Leadership

Problem-solving

Team building

Decision-making

Written and verbal communication

Attention to detail

Medical terminology, ICD and CPT codes

Remote work ability

Typing speed 40 wpm

Attendance is essential

Education

High School Diploma or GED

Job description

OneOncology is seeking a Manager, Pre-Certification to oversee the Pre-Cert team and ensure timely eligibility checks, referrals, and patient estimates across cases.

You will collaborate with vendor partners, Accounts Receivable, and provider staff to minimize patient care disruptions and revenue loss while maintaining payer policy compliance and high service standards in a remote work setting. This role emphasizes leadership, process improvement, and training to support community physicians.