Washington University in St. Louis seeks an experienced Pre-Certification Coordinator II to join the Department of Medicine Business Office. In this advanced role, you will specialize in securing complex pre-certifications for high-dollar oncology and non-oncology drugs to prevent controllable financial losses. You will work remotely, analyzing clinical documentation and payer policies to ensure authorizations are secured.
What You'll Do
- Complete pre-certifications for complex and high-dollar drugs by analyzing therapy plans, drug protocols, clinical notes, payer policies, and patient benefits.
- Manage the full authorization process with payers and document all actions within the Epic EHR system.
- Perform re-checks on existing authorizations by verifying insurance eligibility and confirming all information is accurately documented in Epic.
- Collaborate with clinical staff and providers to resolve add-ons, denials, and peer-to-peer reviews in a timely manner.
- Assist with denials, rejections, and appeals as needed.
What We're Looking For
- High school diploma or equivalent high school certification, or a combination of education and relevant experience.
- 3+ years of experience in a clinical office, medical billing, health information management (HIM), or pre-certification role.
Nice to Have
- Associate degree.
- Previous pre-certification experience and coding knowledge.
- A thorough understanding of Washington University's insurance database and general insurance terminology.
- Experience interacting with managed care plans, insurance companies, and third-party payers.
- Ability to work effectively with internal and external customers, including physicians, nurses, patients, and families.
- Certifications such as Certified Professional Coder (CPC) from AAPC or Registered Health Information Technician (RHIT) from AHIMA.
Technical Stack
- Epic EHR
Benefits & Compensation
- Compensation range: $22.78 - $34.21 per hour.
- Up to 22 days of vacation, 10 recognized holidays, and sick time.
- Competitive health insurance packages with priority appointments and lower copays/coinsurance.
- Free Metro transit U-Pass for eligible employees.
- Defined contribution (403(b)) Retirement Savings Plan with university contributions starting at 7%.
- Comprehensive wellness programs, mental health resources, an employee assistance program (EAP), and access to dietitians.
- 4 weeks of caregiver leave.
- Generous tuition benefits for you and your family, including 100% dependent undergraduate tuition at WashU and 40% elsewhere after seven years.
Work Mode
This is a remote position.
Washington University in St. Louis is committed to the principles and practices of equal employment opportunity and provides 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.
