Scheduled Hours

40

Position Summary

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 re-checks 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.

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 re-checks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all re-check 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

Preferred Qualifications:

• Some college or associate's degree; RHIT and/or CPC certification; coding experience and previous precertification experience.
• Thorough understanding of both WashU insurance database and insurance terminology.
• Excellent communication, interpersonal and organizational skills requires; 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.
• Ability to prioritize multiple tasks, be detail oriented and able to work in a fast paced environment.

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 b