Washington University in St. Louis is hiring a Pre-Certification Coordinator II (Remote) - Department of Medicine

Washington University in St. Louis is hiring a Pre-Certification Coordinator II for its Department of Medicine. This advanced-level, remote role specializes in managing complex pre-certifications for therapy and treatment plans to prevent controllable revenue loss. You will focus on high-dollar drugs, rechecking existing authorizations, and collaborating with clinical staff on add-ons, denials, and peer-to-peer reviews.

What You'll Do

• Complete pre-certifications for complex and high-dollar drugs as indicated on therapy and treatment plans.
• Read and analyze therapy plans, drug protocols, clinical documentation, payer policies, and patient benefits.
• Complete the authorization process with payers and document actions within EPIC.
• Recheck existing pre-certifications by verifying insurance eligibility and all authorization details for applicable services.
• Confirm all recheck information is accurately documented in EPIC.
• Work 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 processes.

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.
• Certified Professional Coder (CPC) certification from the American Academy of Professional Coders (AAPC).
• Registered Health Information Technician (RHIT) certification from AHIMA.
• Strong communication, interpersonal communication, and detail-oriented skills.
• Experience working in fast-paced environments.
• Knowledge of HIPAA regulations and insurance terminology.
• Proficiency in multitasking, prioritization, and organizational savvy.

Technical Stack

• EPIC EHR

Benefits & Compensation

• Compensation: $22.78 - $34.21 / Hourly
• Up to 22 days of vacation and 10 recognized holidays.
• Sick time and 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%.
• Wellness challenges, health screenings, mental health resources, and mindfulness programs.
• Employee assistance program (EAP), financial resources, and access to dietitians.
• 4 weeks of caregiver leave and family care resources.
• Tuition benefits for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years.

Work Mode

This position is fully remote.

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. The University provides equal opportunity and access to 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.