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

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 re-checks 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

• 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 re-checks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all re-check 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.

Required Qualifications

Education:

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

Certifications/Professional Licenses:

No specific certification/professional license 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.

More About This Job

Preferred Qualifications:

• Coding experience and previous pre-certification experience.
• Thorough understanding of both WashU 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.

Preferred Qualifications

Education:

Associate degree

Certifications/Professional Licenses:

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 unless stated elsewhere in the job posting.

Skills:

Communication, Detail-Oriented, Epic EHR, External Customers, Family Communication, Fast-Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), Insurance Claims Processing, Insurance Precertification, Insurance Terminology, Interact with All Levels of Management, Internal Customers, Interpersonal Communication, Managed Care, Medical Coding Software, Multitasking, Organizational Savvy, Patient Interactions, Prioritization, Third Party Payers

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 CandidateQuestions@wustl.edu 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. 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, citizenship (where prohibited by federal law), age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.