Scheduled Hours

40

Position Summary

Position performs various professional services to ensure medical, drug, and diagnostic testing authorizations are obtained in an efficient manner and that 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; is is a liaison between department facilities and physician offices.

Job Description

Primary Duties & Responsibilities:

• 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 in needed.

• Provides training and education to staff.

• Assists staff with complex cases avoiding denials and physician peer to peers; reviews denials to see if there is a potential for re-consideration.

• Provides feedback to management regarding staffing concerns and process improvement; other duties as assigned by manager.

Working Conditions:
Job Location/Working Conditions

• Normal office environment.

Physical Effort

• Typically sitting at desk or table.

• Repetitive wrist, hand, or finger movement.

• Occasional lifting (25 lbs or less).

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:

No specific certification is required for this position.

Work Experience:

Medical Billing/Coding (3 Years)

Skills:

Not Applicable

Driver's License:

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

More About This Job

Required Qualifications:

• Previous pre-certification experience.

Preferred Qualifications:

• Some college or an associate’s degree.
• Coding experience preferred.
• Applicant must have a thorough understanding of both 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.

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, Fast-Paced Environments, Insurance Terminology, Interpersonal Communication, Medical Billing and Coding, 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 que