Lead Pre-Certification Coordinator; Remote - Department of Medicine

Position Summary

Position performs various professional services to ensure medical, drug, and diagnostic testing authorizations are obtained in an efficient manner and reimbursement is maximized through required interaction with third‑party payers. Leads the pre‑certification team to perform and manage the daily workload; responds and resolves questions from the pre‑certification staff in an educational and timely manner; acts as liaison between department facilities and physician offices.

40 hours per week

• Leads the pre‑certification section in daily activities and prioritization of assignments; assists in adjusting daily assignments based on coverage needs of the team and unit.
• Answers the pre‑certification phone lines; assists with billing inquiries, insurance questions, and missing order and pre‑certification issues; acts as liaison between department facilities and physician offices.
• Contacts appropriate insurance companies for benefit verification and pre‑certification of procedures and testing; supplies all documentation required during pre‑certification process to insurance companies.
• Documents when pre‑certification is received from insurance companies and maintains open communication with physicians and their assistants regarding concerns or when physician involvement is needed.
• Provides training and education to staff.
• Assists staff with complex cases to avoid denials and peer‑to‑peer physician review; reviews denials to determine potential for re‑consideration.
• Provides feedback to management regarding staffing concerns and process improvement; other duties as assigned by manager.

Job location:

Normal office environment.

Physical effort:
Sits at a desk; repetitive wrist, hand, or finger movement; occasional lifting (25 lbs or less).

Equipment:
Office equipment.

High‑school diploma or equivalent; or combination of education and/or experience.

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

Medical Billing/Coding – 3 years.

Not applicable.

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

• Previous pre‑certification experience.
• Some college or an associate’s degree.
• Coding experience.
• Thorough understanding of Washington University FSC 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.

Grade: C09-H. Salary range: $23.63 - $35.49 per hour.

• 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, starting at 7% employee plus university contributions.
• Wellness challenges, health screenings, mental health resources, mindfulness programs and courses, employee assistance program, financial resources, access to dietitians.
• 4 weeks of caregiver leave; family care resources for ongoing childcare. Adult care support available.
• Tuition coverage for employees and families: up to 100% at WashU for dependent undergraduates, 40% elsewhere after seven years.

Washington University in St. Louis is committed to the principles and practices of equal employment opportunity. The University’s policy is to provide equal opportunity and access to 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.