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Insurance Specialist
1 month ago
We are seeking a highly skilled Insurance Specialist to join our team at WVU Medicine. The successful candidate will be responsible for ensuring all appointments and procedures are authorized, and will work closely with insurance carriers to verify coverage and benefit limitations.
Key Responsibilities- Identify patients requiring pre-certification or pre-authorization and follow up on accounts as indicated by system flags.
- Contact insurance companies or employers to determine eligibility and benefits for requested services.
- Communicate with patients, insurance companies, or providers to resolve insurance coverage issues and obtain financial resolution.
- Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
- Perform medical necessity screening as required by third-party payors.
- Document referrals/authorization/certification numbers in the EPIC system.
- Initiate charge anticipation calculations and accurately identify anticipated charges to assure identification of anticipated self-pay portions.
- Communicate with patients regarding anticipated self-pay portions, co-payments, deductibles, co-insurance, and account balances.
- Assist Patient Financial Services with denial management issues and appeal denials based on medical necessity as needed.
- Communicate problems hindering workflow to management in a timely manner.
- Assess all self-pay patients for potential public assistance through registration/billing systems and provide self-pay/under-insured patients with financial counseling information.
- High school diploma or equivalent.
- West Virginia state criminal background check required, and Federal, if applicable, for DHHR BMS regulated area.
- Previous insurance authorization experience.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
- Standard office environment.
- Excellent oral and written communication skills.
- Basic knowledge of medical terminology.
- Basic knowledge of ICD-10 and CPT coding, third-party payors, and business math.
- General knowledge of time of service collection procedures.
- Excellent customer service and telephone etiquette.
- Minimum typing speed of 25 words per minute.
- Must have reading and comprehension ability.
