Insurance Authorization & Patient Access Specialist

WVU Medicine; Morgantown (WV); On-site; USD 33,000 - 46,000; Full time

Job summary

WVUH West Virginia University Hospitals is seeking a front-line Insurance Authorization Specialist to assure pre-certification or pre-authorization for services. You will verify coverage with insurers, determine benefits, and assist with financial counseling for patients based on eligibility and coverage.

The role requires a high school diploma, background checks, and experience in insurance authorization. Strong communication and EPIC system proficiency are essential for success in this

Qualifications

• High school diploma or equivalent.
• Background checks required (state and federal where applicable).
• Experience in insurance authorization preferred.

Responsibilities

• Identify patients needing pre-certification or pre-authorization.
• Follow up on accounts via system flags.
• Contact insurers to determine eligibility and benefits.
• Resolve coverage issues with patient or provider for financials.
• Use EPIC work queues for scheduling, care transitions, and billing edits.
• Perform medical necessity screening for payors.
• Document referrals/authorization numbers in EPIC.
• Initiate charge anticipation calculations for anticipated charges.
• Explain expected self-pay portions to patients and refer to Financial Counselors.
• Assist with denial management and appeals when needed.
• Communicate workflow issues to management in a timely manner.
• Assess self-pay patients for public assistance and provide counseling.

Skills

Communication skills

Medical terminology

ICD-10/CPT knowledge

Time of service collection

Customer service

Typing speed 25 wpm

Reading comprehension

Education

High school diploma or equivalent

Job description

WVUH West Virginia University Hospitals is seeking a front-line Insurance Authorization Specialist to assure pre-certification or pre-authorization for services. You will verify coverage with insurers, determine benefits, and assist with financial counseling for patients based on eligibility and coverage.

The role requires a high school diploma, background checks, and experience in insurance authorization. Strong communication and EPIC system proficiency are essential for success in this