Pre-Certification Coordinator II - Remote

Overview

The Pre-Certification Coordinator II specializes in complex pre-certifications for high dollar oncology and non-oncology drugs, ensuring authorization processes are completed efficiently and effectively.

In Short

• Specializes in complex pre-certifications for high dollar drugs.
• Analyzes therapy and treatment plans, drug protocols, and clinical documentation.
• Completes authorization processes with payers and in EPIC.
• Verifies insurance eligibility and authorization information.
• Communicates with clinical staff and providers regarding denials and resolutions.
• Documents all pertinent information in EPIC.
• Assists with denials, rejections, and appeals as needed.
• Works in a normal office environment.
• Requires 3 years of experience in a related field.
• Preferred qualifications include coding experience and knowledge of insurance terminology.

Requirements

• High school diploma or equivalent required.
• 3 years of experience in Clinical Office, Medical Billing, or Pre-Certification.
• Preferred Associate degree or relevant certifications.
• Strong communication skills and detail-oriented approach.
• Experience with Epic EHR and insurance claim processing software.
• Ability to multitask and prioritize in a fast-paced environment.
• Understanding of HIPAA regulations.
• Experience interacting with managed care plans and insurance companies.
• Ability to work with internal and external customers.
• Organizational savvy and interpersonal communication skills.

Benefits

• Up to 22 days of vacation and 10 recognized holidays.
• Competitive health insurance packages.
• Defined contribution retirement savings plan.
• Wellness challenges and mental health resources.
• 4 weeks of caregiver leave for new parents.
• Tuition coverage for employees and their families.
• Access to financial resources and dietitians.
• Employee assistance program (EAP).
• Support for work-life balance and professional growth.
• Inclusive community that values diverse perspectives.