Log In
Sign Up
Summary:
- Position performs various professional services to ensure medical, drug, and diagnostic testing authorizations are obtained in an efficient manner and that reimbursement is maximized through required interaction with third-party payers.
- Leads the pre-certification team to perform and manage the daily workload.
- Responds and resolves questions from the pre-certification staff in an educational and timely manner.
- Acts as a liaison between department facilities and physician offices.
Responsibilities:
- Leads the pre-certification section in daily activities and prioritization of assignments; assists in adjusting daily assignments based on coverage needs of the team and unit.
- Answers the pre-certification phone lines; assists with billing inquiries, insurance questions, and missing order and pre-certification issues; acts as liaison between department facilities and physician offices.
- Contacts appropriate insurance companies for benefit verification and pre-certification of procedures and testing; supplies all documentation required during pre-certification process to insurance companies.
- Documents when pre-certification is received from insurance companies and maintains open communication with physicians and their assistants regarding concerns or when physician involvement is needed.
- Provides training and education to staff.
- Assists staff with complex cases avoiding denials and physician peer to peers; reviews denials to see if there is a potential for re-consideration.
- Provides feedback to management regarding staffing concerns and process improvement; other duties as assigned by manager.
- Job Location/Working Conditions: Normal office environment.
- Physical Effort: Typically sitting at desk or table. Repetitive wrist, hand, or finger movement. Occasional lifting (25 lbs or less).
- Equipment: Office equipment.
Requirements:
- Education: High school diploma or equivalent high school certification or combination of education and/or experience.
- Certifications: No specific certification is required for this position.
- Work Experience: Medical Billing/Coding (3 Years).
- Skills: Not Applicable.
- Driver’s License: A driver’s license is not required for this position.
- Required Qualifications: Previous pre-certification experience.
- Preferred Qualifications: Some college or an associate’s degree. Coding experience preferred. Applicant must have a thorough understanding of both Washington University FSC database and insurance terminology. Experience interacting with managed care plans, insurance companies, and third-party payers. Ability to work with internal and external customers, including physicians, nurses, patients, and families.
- Preferred Education: Associate degree.
- Preferred Certifications: Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) – American Health Information Management Association (AHIMA).
- Preferred Skills: Communication, Detail-Oriented, Fast-Paced Environments, Insurance Terminology, Interpersonal Communication, Medical Billing and Coding, Multitasking, Organizational Savvy, Prioritization.
Benefits:
- Personal: Up to 22 days of vacation, 10 recognized holidays, and sick time. Competitive health insurance packages with priority appointments and lower copays/coinsurance. Take advantage of our free Metro transit U-Pass for eligible employees. WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.
- Wellness: Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!
- Family: We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered. 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.
- For policies, detailed benefits, and eligibility, please visit: https://hr.wustl.edu/benefits/.
- EEO/AA Statement: 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.
- Diversity Statement: Washington University is dedicated to building a diverse community of individuals who are committed to contributing to an inclusive environment – fostering respect for all and welcoming individuals from diverse backgrounds, experiences and perspectives. Individuals with a commitment to these values are encouraged to apply.
