Washington University in St. Louis is hiring a Pre-Certification Coordinator II (Remote) - Pediatrics Hematology & Oncology

Washington University in St. Louis is seeking a Pre-Certification Coordinator II to join the Pediatrics Hematology & Oncology team. In this advanced remote role, you will specialize in complex pre-certifications for high-dollar oncology and non-oncology drugs to prevent revenue loss. You’ll analyze therapy plans and payer policies, manage the authorization process, and perform critical rechecks.

What You'll Do

• Complete pre-certifications for complex, high-dollar drugs as indicated on therapy and treatment plans. Analyze plans, drug protocols, clinical documentation, and payer policies, and complete the authorization process with the payer and in EPIC.
• Perform rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for applicable services, ensuring all information is documented in EPIC.
• Work with clinical staff and providers on add-ons, denials, and peer-to-peer reviews through to timely resolution.
• Perform other duties as assigned, such as assisting with denials, rejections, and appeals.

What We're Looking For

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

Nice to Have

• Associate degree.
• Certification as a Certified Professional Coder (CPC) from AAPC or Registered Health Information Technician (RHIT) from AHIMA.
• 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.
• Previous coding and pre-certification experience.
• Thorough understanding of the Washington University insurance database and insurance terminology.
• Excellent communication, interpersonal, and organizational skills.
• Ability to prioritize multiple tasks, be detail-oriented, and work in a fast-paced environment.

Technical Stack

• Epic EHR
• Insurance Claim Processing Software
• Medical Coding Software

Benefits & Compensation

• Compensation: $22.78 - $34.21 / Hourly
• 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, annual health screenings, mental health resources, mindfulness programs, employee assistance program (EAP), financial resources, and access to dietitians.
• 4 weeks of caregiver leave.
• Family care resources.
• Tuition coverage for employee and family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years.

Work Mode

This position offers a hybrid work mode.

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. It is the University’s policy to provide equal opportunity and access to persons in 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.