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

Washington University in St. Louis

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• The Pre-Certification Coordinator plays a critical role in ensuring timely and accurate pre-authorization of medical procedures, directly impacting patient access to care and the financial integrity of the Department of Medicine at Washington University in St. Louis. This remote position supports seamless coordination between clinical teams, insurance providers, and billing departments to maximize reimbursement and reduce delays in service delivery.
• The role is essential to maintaining compliance with payer requirements and safeguarding revenue cycle efficiency, making it a vital link in the healthcare operations chain that enables physicians to focus on patient care while administrative processes run smoothly behind the scenes.
• Initiates and facilitates the pre-determination process for surgical and nonsurgical procedures by gathering necessary clinical documentation and submitting requests to third-party payers in accordance with payer-specific guidelines.
• Contacts insurance companies directly to verify patient benefits, obtain pre-certifications, and clarify coverage details for both in-network and out-of-network services, ensuring all required authorizations are secured prior to service delivery.
• Compiles and submits all supporting documentation—including clinical notes, procedure codes, and physician orders—to insurance carriers, maintaining meticulous records to support audit readiness and compliance with regulatory standards.
• Maintains an up-to-date daily surgery and procedure schedule for department faculty, serving as the central point of contact for physicians, medical assistants, and clinical coordinators to communicate schedule changes, conflicts, or urgent requests.
• Tracks and logs all pre-certification requests in process, monitoring status updates and promptly notifying the hospital’s utilization management and billing teams upon receipt of approvals or denials to prevent billing delays or claim denials.
• Documents all pre-certification outcomes in the electronic health record or tracking system, ensuring accurate reflection of authorization status for billing and reporting purposes, and follows up on pending or expired requests to avoid lapses in coverage.
• Collaborates with financial counselors to identify services requiring pre-payment due to lack of coding or coverage, facilitating patient communication and payment arrangements when necessary.
• Performs additional administrative duties as assigned by management, contributing to team efficiency and adaptability in a dynamic healthcare environment.
• Works within the Department of Medicine’s Business Office, a supportive and mission-driven team dedicated to optimizing operational excellence, financial stewardship, and patient-centered service delivery across Washington University’s clinical enterprise.
• The role offers exposure to complex healthcare reimbursement systems, managed care protocols, and regulatory compliance standards, providing a strong foundation for career growth in healthcare administration, medical billing, or health information management.
• Employees in this position develop advanced skills in insurance navigation, medical coding fundamentals (CPT, ICD-10), payer communication, and healthcare workflow coordination—competencies highly valued across the healthcare industry and transferable to roles in utilization management, prior authorization, or revenue cycle analysis.

🎯 Requirements

• High school diploma or equivalent (GED) or combination of education and/or experience.
• Minimum of two years of recent experience in a medical office setting, preferably within a hospital, clinic, or physician practice environment.
• Preferred: Some college coursework or an associate degree in health information management, medical billing, or a related field.
• Preferred: Current certification as a Certified Professional Coder (CPC) from AAPC or Registered Health Information Technician (RHIT) from AHIMA.
• Preferred: Demonstrated experience with medical insurance coding (CPT, ICD-10), managed care processes, and third-party payer interactions.
• Strong interpersonal and communication skills, with proven ability to interact effectively with physicians, clinical staff, insurance representatives, and patients.

🏖️ Benefits

• Up to 22 days of paid vacation annually, 10 recognized university holidays, and accrued sick time to support work-life balance and personal well-being.
• Competitive health insurance plans with priority access to WashU physicians, lower copays and coinsurance, and comprehensive medical, dental, and vision coverage options.
• Free Metro transit U-Pass for eligible employees, providing unlimited access to St. Louis public transportation for eco-friendly and cost-effective commuting.
• Eligibility to participate in WashU’s defined contribution 403(b) Retirement Savings Plan, featuring automatic university contributions starting at 7% of salary, plus employee matching opportunities.
• Access to robust wellness programs including annual health screenings, mental health resources, mindfulness courses, financial counseling, dietitian consultations, and an Employee Assistance Program (EAP).
• Generous family benefits: 4 weeks of paid caregiver leave for new children, tuition waivers for employees and dependents (100% for WashU undergraduate tuition after seven years of service, 40% at other institutions), and adult/elder care resources.

Skills & Technologies

Remote

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Washington University in St. Louis

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About Washington University in St. Louis

Washington University in St. Louis is a private research university founded in 1853. It offers undergraduate, graduate, and professional programs across seven schools, including Arts & Sciences, Engineering, Medicine, Law, and Business. Located in St. Louis, Missouri, the university is classified as an R1 doctoral university with very high research activity. It operates a 169-acre Danforth Campus and a 164-acre Medical Campus, along with the Tyson Research Center. The university is affiliated with Barnes-Jewish Hospital and conducts extensive interdisciplinary research in biomedicine, engineering, social policy, and the arts.

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