Lead Pre-Certification Coordinator – Department of Medicine

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversees the daily operations of the pre-certification section and prioritizes tasks accordingly.

• Assists in modifying daily assignments based on the team's and unit's coverage requirements.

• Manages pre-certification phone lines, addressing billing inquiries, insurance questions, and issues related to missing orders and pre-certifications.

• Serves as a liaison between departmental facilities and physician offices.

• Contacts relevant insurance providers for benefit verification and the pre-certification of procedures and tests.

• Provides all necessary documentation during the pre-certification process to insurance companies.

• Records when pre-certifications are received from insurance companies and keeps open communication with physicians and their assistants regarding any concerns or the need for physician involvement.

• Offers training and educational support to staff members.

• Assists staff with complex cases to prevent denials and facilitate physician peer reviews.

• Reviews denials to evaluate the possibility of re-consideration.

• Gives feedback to management concerning staffing issues and opportunities for process improvement.

⛳️ Requirements

• High school diploma or equivalent certification, or a combination of education and/or experience.

• Three years of experience in Medical Billing/Coding.

• Previous experience with pre-certification processes.

• Some college education or an associate’s degree is preferred.

• Coding experience is also preferred.

• Comprehensive knowledge of the Washington University FSC database and insurance terminology.

• Experience with managed care plans, insurance companies, and third-party payers.

• Ability to collaborate effectively with internal and external customers, such as physicians, nurses, patients, and their families.

• Certification as a Professional Coder (CPC) or Registered Health Information Technician (RHIT) is preferred.

🏝️ Benefits

• Up to 22 days of vacation.

• 10 recognized holidays.

• Sick time.

• Competitive health insurance packages that include priority appointments and reduced copays/coinsurance.

• Complimentary 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 and courses, employee assistance programs (EAP), financial resources, and access to dietitians.

• Four weeks of caregiver leave to bond with a new child.

• Family care resources to support ongoing childcare needs.

• Tuition coverage for employees and their families, including up to 100% coverage for dependent undergraduate-level college tuition at WashU and 40% at other institutions after seven years of service.