Insurance Specialist

2 weeks ago


Charleston, West Virginia, United States WVU Medicine Full time
Job Summary

We are seeking a highly skilled Insurance Specialist to join our team at WVU Medicine. As an Insurance Specialist, you will play a critical role in ensuring that all appointments and procedures are authorized, and that insurance carriers are contacted 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.
  • Follow up with patients, insurance companies, or providers to resolve insurance coverage issues.
  • 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.
  • Communicate with patients regarding anticipated self-pay portions, co-payments, deductibles, and account balances.
  • Assist Patient Financial Services with denial management issues and appeal denials based on medical necessity.
  • Communicate workflow problems to management in a timely manner.
  • Assess self-pay patients for potential public assistance and provide financial counseling information.
Requirements
  • High school diploma or equivalent.
  • West Virginia state criminal background check required, and Federal, if applicable, for DHHR BMS regulated area.
Preferred Qualifications
  • Previous insurance authorization experience.
Working Environment

The work environment is a standard office environment with prolonged periods of sitting, extended periods on the telephone, and manual dexterity required to operate standard office equipment.

Skills and Abilities
  • 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.

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