Remote Pre-Certification Operations Manager

Astera Cancer Care; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

OneOncology is seeking a Manager, Pre-Certification to lead the Pre-Cert team, verify patient eligibility and benefits, obtain pre-certs and referrals, and generate accurate patient estimates for procedures.

You will oversee daily schedules with vendor partners, ensure payer policy compliance, coordinate with accounts receivable on denials, and develop training materials while improving processes in a remote environment.

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.
• Excellent written, verbal, and interpersonal communication skills, especially in a virtual work environment.

Responsibilities

• Oversee the daily Pre-Cert schedule to ensure the vendor partner and Pre-Cert team are completing eligibility, benefits, Pre-Certs/referrals, and patient estimates.
• Ensure all cases comply with payer policy and are processed accurately and timely.
• Manage daily workload and balance distribution between vendor partner and UUG Pre-Cert Coordinators.
• Serve as lead point of contact with vendor partner and collaborate to prevent patient care disruptions or revenue loss.
• Audit completed cases for proper procedures, address incorrect patient estimates, and partner with Accounts Receivable on denials.
• Prepare and update training materials and inform vendor partners of new payer or procedure requirements.
• Work with provider staff on cases at risk and determine steps to avoid disruption or loss of revenue.
• Maintain knowledge of payer policy, clinical criteria, and Pre-Cert requirements; drive process improvement and training.

Skills

Leadership

Remote work

Customer service

Communication

Problem solving

Medical terminology

ICD/CPT codes

Typing speed 40 wpm

Team management

Education

High School Diploma or GED

Tools

Medical billing software

Job description

OneOncology is seeking a Manager, Pre-Certification to lead the Pre-Cert team, verify patient eligibility and benefits, obtain pre-certs and referrals, and generate accurate patient estimates for procedures.

You will oversee daily schedules with vendor partners, ensure payer policy compliance, coordinate with accounts receivable on denials, and develop training materials while improving processes in a remote environment.