Insurance Authorization Specialist II

WVU Medicine; Core (WV); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking an Insurance Authorization Specialist II to join their team. This role is vital for ensuring that all appointments and procedures are properly authorized, minimizing reimbursement errors. You will engage with insurance carriers, verify coverage, and assist patients with their financial responsibilities. The ideal candidate will possess excellent communication skills, a basic understanding of medical terminology, and experience with insurance authorization processes. If you are looking to make a meaningful impact in a supportive environment, this opportunity is for you.

Qualifications

• Previous insurance authorization experience preferred.
• Excellent communication skills are essential for this role.

Responsibilities

• Ensure all appointments and procedures are authorized.
• Contact insurance carriers to verify coverage and obtain pre-authorizations.
• Assist with denial management and provide financial counseling.

Skills

Excellent communication skills

Basic medical terminology knowledge

Knowledge of ICD-10 and CPT coding

Understanding of time-of-service collection procedures

Customer service and telephone etiquette

Minimum typing speed of 25 WPM

Good reading and comprehension skills

Education

High school diploma or equivalent

Tools

EPIC

Job description

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Position Overview

This role is responsible for ensuring all appointments and procedures are authorized. Responsibilities include contacting insurance carriers to verify coverage, obtaining pre-authorizations, scheduling tests and procedures, calculating deductibles, co-payments, account balances, and fees, and adding notations to the system for front-end collection. The goal is to minimize reimbursement errors caused by referral and enrollment inaccuracies.

Minimum Qualifications

Education, Certification, and/or Licensure

• High school diploma or equivalent.
• West Virginia state criminal background check required; federal background check if applicable for DHHR BMS regulated area.

Experience

Preferred Qualifications

• Previous insurance authorization experience.

Core Duties and Responsibilities

Responsibilities include identifying patients requiring pre-certification, following up on accounts, determining eligibility and benefits, resolving coverage issues, using work queues within EPIC, performing medical necessity screening, documenting authorization numbers, calculating anticipated charges, communicating with patients about their financial responsibilities, assisting with denial management, and providing financial counseling for self-pay patients.

Physical Requirements

• Prolonged sitting.
• Extended telephone use requiring clarity of hearing and speaking.
• Manual dexterity for operating office equipment.

Work Environment

• Standard office setting.

Skills and Abilities

• Excellent communication skills (oral and written).
• Basic medical terminology knowledge.
• Knowledge of ICD-10 and CPT coding, third-party payors, and business math.
• Understanding of time-of-service collection procedures.
• Customer service and telephone etiquette.
• Minimum typing speed of 25 WPM.
• Good reading and comprehension skills.

Additional Details

• Scheduled weekly hours: 40
• Employment type: Full-time, Non-Exempt
• Shift: United States, Non-Exempt
• Company: WVU Medicine
• Cost Center: 536 SYSTEM Hospital Authorization Unit

Job Information

• Seniority level: Entry level
• Job function: Other
• Industry: Hospitals and Health Care