Healthcare Insurance Authorization Specialist

Wheeling Hospital, Inc.; Wheeling (WV); On-site; USD 36,000 - 48,000; Full time

Job summary

Wheeling Hospital, Inc. is seeking a detail-oriented Insurance Verification/Pre-Certification Specialist to join our team in Wheeling, WV. You will identify patients needing pre-certification, determine eligibility with payors, and document all steps in EPIC.

Strong communication and medical terminology knowledge are essential. In this role, you will handle charge anticipation, discuss self-pay portions with patients, and coordinate with Financial Counselors to resolve coverage issues.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal (if applicable), as required for regulated areas.

Responsibilities

• Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
• Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
• Performs medical necessity screening as required by third party payors.
• Documents referrals/authorization/certification numbers in the EPIC system.
• Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
• Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
• Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
• Communicates problems hindering workflow to management in a timely manner.
• Assess all self-pay patients for potential public assistance through registration/billing systems Provides self-pay/under-insured patients with financial counseling information. Maintains current knowledge of major payor payment provisions.

Skills

Communication skills

Medical terminology

ICD-10 & CPT knowledge

Billing knowledge

Customer service

Typing 25 wpm

Education

High school diploma

Tools

EPIC

Job description

Wheeling Hospital, Inc. is seeking a detail-oriented Insurance Verification/Pre-Certification Specialist to join our team in Wheeling, WV. You will identify patients needing pre-certification, determine eligibility with payors, and document all steps in EPIC.

Strong communication and medical terminology knowledge are essential. In this role, you will handle charge anticipation, discuss self-pay portions with patients, and coordinate with Financial Counselors to resolve coverage issues.