Job Description

Job Title

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; is a liaison between department facilities and physician offices.

Primary Duties & Responsibilities:

• Leads the pre-certification section in daily activities and prioritization of assignments and manage daily workload; assists in adjusting daily assignments based on coverage needs of the team and unit. Responds and resolves questions from pre-certification staff and clinical teams in a timely manner.
• 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; answers billing/insurance questions from patients.
• 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 for surgical and radiology services.
• 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.

Working Conditions:

• Normal office environment.
• Typically sitting at desk or table.
• Repetitive wrist, hand, or finger movement.
• Occasional lifting (25 lbs or less).

• Office equipment.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications:

• Previous pre-certification experience.

Preferred Qualifications:

• Some college or an associate's degree.
• Coding experience.
• 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.

Education: Associate degree

Certifications: Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Work Experience: No additional work experience beyond what is stated in the Required Qualifications section.

Skills: Communication, Detail-Oriented, Fast-Paced Environments, Insurance Terminology, Interpersonal Communication, Medical Billing and Coding, Multitasking, Organizational Savvy, Prioritization, Teamwork, Written Communication

Grade: C09-H

Salary Range: $22.78 - $34.21 / Hourly

For frequently asked questions about the application process, please refer to our

All qualified individuals must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.

All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.

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:

EEO 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. Washington University is dedicated to building a 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.

Job Tags

Similar Jobs