Lead Pre-Certification Coordinator – Department of Medicine

Responsibilities

• Leads the pre-certification section in daily activities and prioritization of assignments
• Assists in adjusting daily assignments based on coverage needs of the team and unit
• 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
• 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
• 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 pears
• Reviews denials to see if there is a potential for re-consideration
• Provides feedback to management regarding staffing concerns and process improvement

Requirements

• High school diploma or equivalent high school certification or combination of education and/or experience
• Medical Billing/Coding (3 Years)
• Previous pre-certification experience
• Some college or an associate’s degree preferred
• Coding experience preferred
• Thorough understanding of 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
• Certified Professional Coder (CPC) or Registered Health Information Technician (RHIT) preferred

Core Competencies

Demonstrates expertise in pre-certification processes, medical billing, and coding, with a strong ability to communicate effectively with healthcare professionals and insurance companies. Proficient in managing complex cases and providing training to staff while ensuring compliance with insurance requirements.

Highest-signal resume keywords

• Medical Billing/Coding
• Pre-Certification Experience
• Certified Professional Coder (CPC)
• Registered Health Information Technician (RHIT)
• Washington University FSC Database

Hard Skills

• Medical Billing
• Medical Coding
• Pre-Certification Processes
• Insurance Verification
• Documentation Management

Soft Skills

• Communication
• Team Leadership
• Problem Solving
• Customer Service

Certifications & Qualifications

• Certified Professional Coder (CPC)
• Registered Health Information Technician (RHIT)

Industry Keywords

• Insurance Terminology
• Managed Care Plans
• Third-Party Payers
• Healthcare Compliance