Pre-Certification Coordinator II – Department of Medicine
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Pre-Certification Coordinator II managing complex pre-certifications for the Department of Medicine. Analyzing and authorizing specialized services with clinical staff and providers.
Responsibilities:
- Completes pre-certifications for complex and specialized services as indicated on therapy and treatment plans
- Reads and analyzes therapy and treatment plans, drug protocols, and clinical documentation, as well as payer policies and patient benefits
- Completes the authorization process with the payer and in EPIC
- Completes rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for applicable services
- Confirms all recheck information is documented in EPIC
- Works with clinical staff and providers on add-ons, denials, and peer to peers through to resolution in a timely fashion
- Performs other duties as assigned, including assistance with denials, rejections, and appeals
Requirements:
- High school diploma or equivalent certification or combination of education and/or experience
- 3 years of experience in Clinical Office, Medical Billing, Health Information Management (Him), or Pre-Certification
- No specific certification/professional license is required for this position
- Skills: Not Applicable
Benefits:
- Up to 22 days of vacation
- 10 recognized holidays
- 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 starting at 7%
- Wellness challenges, annual health screenings, mental health resources, mindfulness programs, employee assistance program (EAP), financial resources, access to dietitians
- 4 weeks of caregiver leave to bond with your new child
- WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us.
Similar Jobs
Residential Mortgage Specialist
Residential Mortgage Specialist originating mortgage loans while guiding applicants through the process at Associated Bank. Building relationships and achieving sales goals through a multi-channel approach.
Pre-Certification Coordinator I
Pre-Certification Coordinator ensuring efficient processing of medical and surgical services at a leading university medical department. Engaging with insurance for verification and pre-certification tasks.
Delegation Oversight Coordinator
Delegation Oversight Coordinator managing reporting processes and monitoring delegated entities for HCSC. Ensuring compliance with regulatory standards and conducting financial audits for assigned products and business lines.
Advertising Specialist
Amazon Advertising Specialist managing end-to-end ad performance for a growing ecommerce auto parts brand. Responsible for campaign optimization, performance metrics, and scaling strategy.
Field Service Technician – Robotics
Technicien itinérant pour le service après-vente Robotique chez Stäubli, fournisseur de solutions mécatroniques. Interventions techniques dans des industries de pointe en Haute-Savoie.
Dispatch Coordinator
Remote Dispatch Coordinator handling emergency customer service calls at SERVPRO. Scheduling and coordinating response teams for effective customer service during critical situations.
Site Contracts Lead, Europe
Site Contracts Lead overseeing clinical trial agreements and mentoring specialists. Collaborating with internal and external stakeholders to manage contracting processes efficiently.
Senior Media Specialist
Sr. Media Specialist managing media strategies and buying for clients at a marketing agency. Role includes client interactions, media negotiation, and performance analysis.
Inpatient Eligibility Specialist
Inpatient Eligibility Specialist role providing virtual support to uninsured and under-insured patients for Medicaid and Financial Assistance programs. Guides patients through application processes and eligibility options via phone.
Professional Coding Spec II – Outreach
Coding Specialist responsible for accurate medical record coding and compliance within WVU Health System. Collaborating with physicians and Revenue Cycle Operations for optimal coding and billing accuracy.
Head of Electrical Safety, Authorised Person
Head of Electrical Safety responsible for electrical competence and safety at Anord Mardix. Ensuring compliance with safety regulations while reporting to the Global EHS Director.
Nachhilfelehrer – Englisch, Deutsch, Französisch, Spanisch, Wirtschaft
Become a tutor for English/German & French/Spanish at ubiMaster, a growing education company in Germany. Enjoy flexible work arrangements while helping students achieve their academic goals.
PC-12 First Officer – Legacy Crew
First Officer supporting Captain in operating PC-12 aircraft for regional charter flights. Essential for ensuring safety and efficiency while adhering to FAA regulations.
Lead On Site Services Specialist – Turbine Controls
Lead Field Engineer responsible for installation and troubleshooting of GE Software & Controls Solutions. Work includes Oil & Gas and Power Generation industries.
Internal Wholesaler – LTC
Internal Wholesaler at Crump driving sales by building relationships with agents and producers in the life insurance industry. Promoting agent recruiting and retention through innovative marketing strategies.
Freelance Photo Retoucher
Freelance photo retoucher working with Catbird’s creative team on jewelry photography. Responsible for retouching, color correction, and maintaining visual standards.
Inpatient Denials Integrity Specialist
Inpatient Denials Integrity Specialist responsible for analyzing coding-related hospital claims and resolving denials. Collaborating with billing and coding teams, supporting appeals, and ensuring compliance.
Commissioning Specialist – Separation
Commissioning Specialist executing start-up and commissioning at customer locations. Focusing on mechanical, electrical, and electronic components for optimized performance.
Payor Relations Coordinator
Payor Relations Coordinator responsible for financial analysis and maintenance of managed care contracts. Collaborating with various internal departments to resolve issues and optimize reimbursement.
Servicio Médico Ocupacional
Médico ocupacional encargado de la vigilancia de la salud de los trabajadores en NESsT. Lectura de exámenes médicos y elaboración de informes técnicos para cumplimiento normativo.