Pre-Certification Coordinator II (Remote) - Department of Medicine - Business Office

📋 Description

• • As a Pre-Certification Coordinator II within the Department of Medicine's Business Office at Washington University in St. Louis, you will play a critical role in ensuring the financial health of the department by meticulously managing complex pre-certification processes for high-value oncology and non-oncology drugs.
• • This advanced-level position requires a deep understanding of therapy and treatment plans, drug protocols, clinical documentation, and payer policies to proactively prevent revenue losses and write-offs.
• • Your primary responsibility will involve completing pre-certifications for intricate and costly medications, analyzing detailed treatment plans, and ensuring all necessary clinical information aligns with payer requirements and patient benefits.
• • You will be the key liaison with payers to navigate the authorization process, meticulously documenting all pertinent information within the Epic electronic health record (EHR) system.
• • Beyond initial authorizations, you will conduct regular re-checks of existing pre-certifications, verifying insurance eligibility and confirming authorization details for all applicable services, ensuring accuracy and completeness in Epic.
• • A significant aspect of this role involves close collaboration with clinical staff and providers, addressing add-ons, managing denials, and facilitating peer-to-peer reviews to achieve timely resolutions.
• • You will also be instrumental in assisting with the appeals process for denied or rejected claims, contributing to the overall revenue cycle management.
• • This remote position offers the flexibility to work from home while maintaining a high level of engagement and communication with internal teams and external stakeholders.
• • The role demands exceptional attention to detail, strong analytical skills, and the ability to interpret complex medical and insurance documentation.
• • You will be expected to maintain up-to-date knowledge of insurance terminology, payer policies, and the evolving landscape of healthcare regulations.
• • Effective communication is paramount, as you will interact with physicians, nurses, patients, and their families, providing clear and concise information regarding the pre-certification status.
• • The ability to manage multiple priorities in a fast-paced environment, coupled with strong organizational skills, will be essential for success.
• • You will contribute to a seamless patient care experience by ensuring that necessary authorizations are in place before treatments commence, thereby minimizing patient and departmental financial burdens.
• • This position is integral to the financial operations of the Department of Medicine, directly impacting its ability to provide essential services without undue financial strain.
• • Your work will support the department's mission by ensuring that all treatments are properly authorized, allowing clinical teams to focus on patient care rather than administrative hurdles.
• • You will be a vital part of a team dedicated to optimizing the revenue cycle and maintaining financial integrity within a leading academic medical institution.
• • The role requires a proactive approach to problem-solving, identifying potential issues before they escalate and implementing effective solutions.
• • You will leverage your expertise in medical billing and pre-certification processes to streamline workflows and improve efficiency.
• • This is an opportunity to grow your career in healthcare administration within a respected university setting, contributing to a critical function that supports both patient care and departmental operations.
• • The ability to work independently and as part of a collaborative team is crucial for this remote role.
• • You will be responsible for maintaining confidentiality and adhering to all HIPAA regulations.
• • Your contributions will directly support the delivery of advanced medical treatments by ensuring the financial pathways are clear and approved.
• • This position offers a chance to develop specialized expertise in the complex world of medical insurance authorizations and healthcare finance.
• • You will be a key player in the administrative backbone of the Department of Medicine, ensuring that complex treatments can proceed without financial impediments.
• • The role requires a commitment to accuracy and a thorough understanding of the pre-certification lifecycle from initiation to resolution.
• • You will be empowered to make informed decisions regarding authorization processes, contributing to departmental efficiency and financial stability.
• • This is a challenging yet rewarding role for an individual passionate about healthcare administration and patient advocacy within the financial realm.
• • Your analytical skills will be put to the test as you decipher payer policies and clinical requirements to secure necessary approvals.
• • You will be a critical point of contact for insurance-related inquiries, providing expert guidance and support.
• • The position offers a stable and supportive work environment within a renowned institution, with opportunities for professional development.
• • You will contribute to a positive patient experience by ensuring that financial barriers to care are addressed proactively and efficiently.
• • This role is essential for managing the financial risks associated with high-cost medical treatments and therapies.
• • Your dedication to accuracy and thoroughness will be instrumental in preventing claim denials and ensuring timely reimbursement.
• • You will be an integral part of the Department of Medicine's Business Office, contributing to its overall success and operational excellence.
• • This position requires a strong understanding of the interplay between clinical care, insurance processes, and financial outcomes.
• • You will be responsible for maintaining clear and organized documentation within the Epic system, ensuring audit readiness and efficient information retrieval.
• • The ability to adapt to changing insurance regulations and payer requirements is essential for this dynamic role.
• • You will be a key contributor to the financial well-being of the department by ensuring all necessary pre-authorizations are obtained promptly and accurately.
• • This role offers a unique opportunity to specialize in a critical area of healthcare administration, making a tangible impact on patient access to care and departmental financial stability.