Insurance Authorization Specialist

WVU Medicine; Morgantown (WV); On-site; USD 25,000 - 39,000; Full time

Job summary

WVUH West Virginia University Hospitals in Morgantown, WV seeks a healthcare billing specialist responsible for securing pre-certifications, verifying coverage, and scheduling pre-authorizations. This role requires strong communication, knowledge of ICD-10/CPT coding, and proficient use of EPIC systems.

Responsibilities include identifying patients for authorization, resolving coverage issues, and guiding self-pay decisions with patients.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal background check if applicable.

Responsibilities

• Identify patients requiring pre-certification or pre-authorization at the time of service or when notified by other departments.
• 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/providers to resolve insurance coverage issues.
• Use EPIC work queues for scheduling, transition of care, and billing edits.
• Perform medical necessity screening as required by third party payors.
• Document referrals/authorization/certification numbers in EPIC.
• Initiate charge anticipation calculations and identify anticipated self-pay portions.
• Communicate anticipated self-pay portions to patients and refer to Financial Counselors as needed.
• Assist with denial management issues and appeal denials based on medical necessity.
• Report workflow problems to management promptly.
• Assess self-pay patients for potential public assistance and provide financial counseling information.

Skills

Excellent oral and written comms

Medical terminology

ICD-10/CPT coding knowledge

Third party payors knowledge

Time of service collection

Customer service/telephone etiquette

Typing speed 25 wpm

Reading/comprehension

Education

High school diploma or equivalent

Job description

WVUH West Virginia University Hospitals in Morgantown, WV seeks a healthcare billing specialist responsible for securing pre-certifications, verifying coverage, and scheduling pre-authorizations. This role requires strong communication, knowledge of ICD-10/CPT coding, and proficient use of EPIC systems.

Responsibilities include identifying patients for authorization, resolving coverage issues, and guiding self-pay decisions with patients.