Pre-Certification Coordinator II; Remote - Department of Medicine

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 rechecks 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‑peer resolutions in a timely fashion.
• Assists with denials, rejections and appeals as required.

• Education:
  
  High school diploma or equivalent.
• Experience:
  
  Clinical office, medical billing, health information management (HIM), or pre‑certification experience (3 years).
• Skills:
  
  Proficiency with EPIC EHR, understanding of insurance pre‑certification, attention to detail, communication with internal and external customers, ability to multitask, and knowledge of HIPAA and managed care terminology.
• License:
  Driver’s license not required.

• Associate degree in a related field.
• Certifications:
  
  Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC) or Registered Health Information Technician (RHIT) – American Health Information Management Association (AHIMA).
• Skills:
  
  Communication, detail‑oriented, Epic EHR, external customers, family communication, fast‑paced environments, HIPAA compliance, insurance claim processing software, insurance precertification, insurance terminology, interaction 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: $23.63 – $35.49 per hour (base salary). Individual rates are determined by qualifications, performance, market rates, and department budget.

• Up to 22 days of vacation, 10 recognized holidays, and sick time.
• Competitive health insurance packages with priority appointments and lower copays/coinsurance.
• Free Metro Transit U‑Pass for eligible employees.
• Defined contribution 403(b) retirement savings plan with employee contributions and university matching starting at 7%.
• Wellness programs, mental health resources, employee assistance program, financial resources, and access to dietitians.
• Family benefits including 4 weeks caregiver leave, childcare resources, and tuition coverage for dependents.

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.