Pre-Certification Coordinator (Remote) - Surgery

📋 Description

• • As a Pre-Certification Coordinator at Washington University in St. Louis, you will play a pivotal role in ensuring the seamless and efficient delivery of medical and surgical services, directly impacting patient care pathways and the financial health of the department.
• • Your primary responsibility will be to initiate and meticulously manage the pre-determination process for a wide range of surgical and non-surgical procedures, acting as the crucial link between healthcare providers and third-party payers.
• • This involves proactively contacting appropriate insurance companies to conduct thorough benefit verifications, confirming coverage details, and obtaining necessary pre-certifications before procedures are performed.
• • You will be the gatekeeper of essential documentation, ensuring that all required information is accurately supplied to insurance companies to facilitate the pre-certification process, thereby minimizing potential claim denials and delays.
• • A key aspect of your role will be to maintain an up-to-date daily surgery and procedure schedule for the department's esteemed faculty, requiring constant and clear communication with physicians and their administrative assistants to ensure everyone is informed and aligned.
• • You will establish and maintain a comprehensive written log of all pre-certifications currently in process, providing a clear overview of pending authorizations and their status.
• • This log will be instrumental in notifying the hospital utilization and billing departments of the pre-certification status, enabling them to manage resources and patient accounts effectively.
• • You will be responsible for meticulously documenting when pre-certification is successfully obtained from insurance companies, ensuring a complete and auditable record.
• • Your role extends to collaborating with financial counselors, informing them of any un-coded services that require pre-payment, thereby safeguarding against financial shortfalls.
• • Beyond these core duties, you will be expected to perform other assigned tasks that contribute to the overall efficiency and effectiveness of the department's administrative and financial operations.
• • This position operates within a normal working environment, which may include a patient care setting, requiring a professional demeanor and adherence to healthcare protocols.
• • The physical demands of the role are typically sedentary, involving sitting at a desk or table for extended periods, with repetitive wrist, hand, or finger movements associated with computer use and administrative tasks.
• • You will utilize standard office equipment to perform your duties, ensuring efficient workflow and accurate record-keeping.
• • This role is critical in optimizing reimbursement by ensuring all necessary approvals are secured in advance, directly contributing to the financial stability and operational capacity of the surgical department.
• • By proactively managing the pre-certification process, you will help prevent unexpected financial burdens for patients and the institution, fostering a smoother patient experience from scheduling to procedure.
• • Your attention to detail and organizational skills will be paramount in navigating the complex landscape of medical insurance policies and requirements.
• • You will be an integral part of a team dedicated to providing high-quality patient care by ensuring all administrative and financial prerequisites are met with precision and timeliness.
• • This remote position offers the flexibility to work from home while maintaining critical communication channels with both internal stakeholders and external insurance providers.
• • The ability to manage your time effectively and work independently is essential for success in this remote capacity.
• • You will contribute to the University's mission by ensuring that patient care services are delivered efficiently and that reimbursement is maximized through diligent adherence to pre-certification protocols.
• • This role requires a proactive approach to problem-solving, identifying potential issues in the pre-certification process and implementing solutions to ensure timely approvals.
• • You will be a key point of contact for insurance-related inquiries concerning patient procedures, requiring clear and concise communication skills.
• • The successful candidate will demonstrate a commitment to accuracy and thoroughness in all documentation and communication related to pre-certifications.
• • This position offers an excellent opportunity to gain in-depth experience in healthcare administration and revenue cycle management within a prestigious academic medical institution.