Pre-Certification Coordinator II (Remote) - Department of Medicine

Scheduled Hours 40 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. Job Description Primary Duties & Responsibilities: 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 peers through to resolution in a timely fashion. Performs other duties as assigned, such as assistance with denials, rejections and appeals. Working Conditions: 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. Required Qualifications 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. More About This Job WashU seeks highly motivated individuals who are able to perform duties in a manner consistent with our core mission and guiding principles. 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, External Customers, Family Communication, Fast-Paced Environments, Health Insurance Portability & Accountability Act (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 View email address on click.appcast.io or call the dedicated accommodation inquiry number at View phone number on click.appcast.io 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. Pre-Employment Screening 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. Benefits Statement 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. For policies, detailed benefits, and eligibility, please visit: EEO Statement 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. Q: Can I create a job alert to notify me when jobs of interest are posted? A: Yes! After you create a Candidate Home account, you can set up and manage job alerts to be sent to you either daily or weekly, according to the filters you select. You can add, edit, or delete job alerts at any time. You will need to opt in to communications from WashU when you set up your first alert and will only receive alerts for jobs posted after the alert has been created. Set alerts today so you do not miss any new opportunities! Washington University in St. Louis' collective success is significantly attributed to the passion and outstanding efforts of our community. Our staff, faculty and trainees are committed to excellence and dedicated to carrying out our missions of research, teaching and patient care. WashU prides itself on being a place where people matter, and serious work is done. Our people work together in an inclusive community that celebrates diverse perspectives, collaboration and innovation. We are a community of individuals inspired to work together to develop big ideas and tackle challenging problems. We value the well-being of our people. WashU strives to create a positive employee experience where staff, faculty and trainees thrive, both personally and professionally. Our employees find meaning, connection and vitality in their work and life with a healthy work-life balance and support to learn, grow and make an impact at WashU, the community and the world. Useful Links Who We Are Human Resources Benefits Living in St. Louis Frequently Asked Questions Accommodation If you are unable to use our online application system and would like an accommodation, please email View email address on click.appcast.io or call the dedicated accommodation inquiry number at View phone number on click.appcast.io and leave a voicemail with the nature of your request. Regulatory Postings Know Your Rights: Workplace Discrimination is Illegal Poster (English; Spanish)