Pre-Certification Coordinator II - Internal Medicine

Location Remote, US Scheduled Hours 40 Position Summary This advanced level Pre-certification Coordinator specializes in complex pre-certifications for high dollar oncology and/or non-oncology drugs as indicated on therapy and treatment plans to prevent controllable losses/write offs for the Department. This position may also perform rechecks of insurance eligibility and verify authorization information for each service. This position will also document all pertinent authorization information in Epic and communicate with clinical staff and providers in a timely and effective manner. Job Description Primary Duties & Responsibilities: Completes pre-certifications for complex and high dollar drugs as indicated on therapy and treatment plans. Must read and analyze therapy and treatment plans, drug protocols and clinical documentation, as well as payer policies and patient benefits. Completes the authorization process with the payer and in EPIC. Completes rechecks on existing pre-certifications by verifying insurance eligibility and all authorization information for all applicable services. Confirms all recheck information is documented in EPIC. Works with clinical staff and providers on add-ons, denials and peer to peers through to resolution in a timely fashion. Other duties as assigned, such as assistance with denials, rejections and appeals. Working Conditions: Job Location/Working Conditions Normal office environment Physical Effort Typically sitting at desk or table Equipment 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 Education: High school diploma or equivalent high school certification or combination of education and/or experience. Certifications