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Insurance Specialist RMH Neurobehavioral

2 months ago

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

We are seeking an experienced Insurance Specialist to join our team at RMH Reynolds Memorial Hospital. 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 problems hindering workflow to management in a timely manner.
Requirements
  • 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.
Working Environment

This 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.