Pre-Certification Coordinator II (Remote) - Internal Medicine

Location

Remote, US

40

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 rechecks 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.

• 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 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 peers through to resolution in a timely fashion.
• Other duties as assigned, such as assistance with denials, rejections and appeals.

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.

• 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.

• Coding experience and previous pre-certification experience preferred.
• Applicant must have a thorough understanding of both Washington University 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, Fast-Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), Insurance Terminology, Interpersonal Communication, Multitasking, Organizational Savvy, Prioritization

$23.63 - $35.49 / Hourly

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…