Pre-Certification Coordinator II; Remote - Orthopedic Surgery

Overview

Position Summary

Advanced level specialization in complex pre-certifications as indicated on therapy and treatment plans to prevent controllable losses/write offs for the department. May perform rechecks of insurance eligibility and verify authorization information for each service. Documents all pertinent authorization information in EPIC and communicates with clinical staff and providers in a timely and effective manner.

• Completes pre-certifications for complex and specialized services as indicated on therapy and treatment plans. Reads and analyzes 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 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.
• Performs other duties as assigned, such as assistance with denials, rejections and appeals.

• Normal office environment.
• Typically sitting at desk or table.
• Office equipment.

Note: Text converted for formatting; original language retained where applicable.

Education: Required:
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.

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, HIPAA, Insurance Claim Processing Software, 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 Candidate Questions or call the dedicated accommodation inquiry number at  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.

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.

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…