Pre-Certification Coordinator II; Remote - Department of Medicine - Business Office

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 re‑checks 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.

40 hours per week.

• 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 reviews through 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.

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

No specific certification/professional license is required for this position.

Clinical Office, Medical Billing, Health Information Management (HIM), or Pre‑Certification (3 Years).

Not applicable.

A driver's license is not required for this position.

Associate degree.

Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) – American Health Information Management Association (AHIMA).

No additional work experience unless stated elsewhere in the job posting.

Communication, Detail‑Oriented, Epic EHR, External Customers, Family Communication, Fast‑Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), 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.

C09-H

$23.63 – $35.49 per hour.

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.

WashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles.

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.