Pre-Certification Coordinator II – Internal Medicine

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WashU IT

WebsiteLinkedInAll Job Openings

501 - 1000 employees

📚 Education

🏢 Enterprise

☁️ SaaS

Education • Enterprise • SaaS

WashU IT is the information technology department of Washington University in St. Louis, providing essential IT services and support for the university's students, faculty, and staff. The department is integral to facilitating the university’s academic, research, and administrative functions, ensuring that technological resources and solutions are efficiently delivered and maintained across the university’s campuses. WashU IT also plays a crucial role in helping the university confront complex technological challenges and enhance its operational capabilities.

📋 Description

• Completes pre-certifications for complex and high dollar drugs as indicated on therapy and treatment plans • Read and analyze therapy and treatment plans, drug protocols, and clinical documentation • Completes the authorization process with the payer and in EPIC • Completes rechecks on existing pre-certifications by verifying insurance eligibility • Communicates with clinical staff and providers regarding add-ons, denials, and peer to peers • Other duties as assigned such as assistance with denials, rejections, and appeals

🎯 Requirements

• High school diploma or equivalent high school certification or combination of education and/or experience • Clinical Office, Medical Billing, Health Information Management (HIM), or Pre-Certification experience (3 Years) • Coding experience and previous pre-certification experience preferred • Thorough understanding of Washington University insurance 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 • Communication, Detail-Oriented, Epic EHR, Fast-Paced Environments, HIPAA, Insurance Terminology, Interpersonal Communication, Multitasking, Organizational Savvy, Prioritization skills

🏖️ 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 and annual health screenings • Mental health resources and mindfulness programs • Employee assistance program (EAP) • Financial resources and access to dietitians • 4 weeks of caregiver leave for bonding with a new child • Cost of tuition coverage for employee and family