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

About the role

The 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. The role leads the pre-certification team to perform and manage the daily workload, answers the pre-certification phone lines, assists with billing inquiries, insurance questions, and missing order and pre-certification issues, acts as a liaison between department facilities and physician offices, contacts appropriate insurance companies for benefit verification and pre-certification of procedures and testing, documents when pre-certification is received from insurance companies, maintains open communication with physicians and their assistants regarding concerns or when physician involvement is 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, and other duties as assigned by manager.

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 is needed
• Provides training and education to staff
• Affords assistance to 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
• Performs other duties as assigned by manager

Requirements

Previous pre-certification experience.

Qualifications

• High school diploma or equivalent high school certification or combination of education and/or experience
• Medical Billing/Coding (3 Years)
• Some college or an associate’s degree
• Coding experience
• 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

Skills

Communication, Detail-Oriented, Fast-Paced Environments, Insurance Terminology, Interpersonal Communication, Medical Billing and Coding, Multitasking, Organizational Savvy, Prioritization

Benefits

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. 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.

Pay

$23.63 - $35.49 / Hourly

Schedule

Normal office environment. Physical Effort: Typically sitting at desk or table. Repetitive wrist, hand, or finger movement. Occasional lifting (25 lbs or less).