Washington University in St. Louis is hiring a Pre-Certification Coordinator II to join its Orthopedic Surgery department. This advanced-level remote role specializes in complex pre-certifications to prevent revenue loss, working closely with clinical staff and providers to ensure therapy and treatment plans are authorized. You'll document all pertinent information in EPIC and verify insurance eligibility in a timely and effective manner.

What You'll Do

Complete pre-certifications for complex and specialized services by analyzing therapy plans, drug protocols, clinical documentation, and payer policies.
Perform re-checks on existing pre-certifications by verifying insurance eligibility and authorization information, documenting all details in EPIC.
Work with clinical staff and providers to resolve add-ons, denials, and peer-to-peer reviews.
Assist with denials, rejections, and appeals as assigned.

What We're Looking For

High school diploma or equivalent combination of education and experience.
3+ years of experience in a Clinical Office, Medical Billing, Health Information Management (HIM), or Pre-Certification role.

Nice to Have

Associate degree.
Certification such as Certified Professional Coder (CPC) from AAPC or Registered Health Information Technician (RHIT) from AHIMA.
Proficiency in communication, detail-oriented work, EPIC EHR, insurance terminology, managed care, multitasking, and working with internal and external customers in fast-paced environments.

Technical Stack

EPIC EHR
Insurance Claim Processing Software
Medical Coding Software

Benefits & Compensation

Compensation: $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%.
Wellness challenges, health screenings, mental health resources, mindfulness programs, EAP, financial resources, and dietitian access.
4 weeks of caregiver leave and family care resources.
Tuition assistance for you and your family, including 100% dependent undergraduate tuition at WashU after seven years.

Work Mode

This is a fully remote position.

Washington University in St. Louis is committed to building an inclusive community and provides equal opportunity and access to all persons without regard to race, ethnicity, color, national origin, age, religion, sex, sexual orientation, gender identity or expression, disability, protected veteran status, or genetic information.