Insurance Specialist
2 weeks ago
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.
- 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 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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