Scheduled Hours
40
Position Summary
Advanced level Pre-certification Coordinator specializes in complex pre-certifications for endocrinology & diabetes drugs, infusions, medical equipment, and procedures 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. May coordinate appeals and peer to peer calls for providers. Documents all pertinent authorization information in EPIC and communicates with clinical staff, providers, and patient families in a timely and effective manner.
Job Description
Primary Duties & Responsibilities:
- Initiates and facilitates predetermination process.
- Contacts appropriate insurance/DME/pharmacy companies for benefit verification and pre-certification of procedures, medications, and laboratory tests.
- Supplies all documentation required during pre-certification process.
- Maintains appropriate documentation and tracking of all pre-certification requests.
- Other duties as assigned.
Working Conditions:
Job Location/Working Conditions
Physical Effort
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:
No specific certification 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
Preferred Qualifications:
- 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:
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 beyond what is stated in the Required Qualifications section.
Skills:
Communication, Detail-Oriented, Epic EHR, Fast-Paced Environments, Health Insurance Portability & Accountability Act (HIPAA), Insurance Claim Processing Software, Insurance Precertification, Insurance Terminology, Interpersonal Communication, Medical Coding Software, Multitasking, Organizational Savvy, Prioritization
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 [email protected] or call the dedicated accommodation inquiry number at 314-935-1149 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: https://hr.wustl.edu/benefits/
EEO Statement
Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and especially encourages applications by those from underrepresented groups. 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, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.
Washington University is dedicated to building a community of individuals who are committed to contributing to an inclusive environment – fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.