Insurance Operations Lead

wvumedicine; Wheeling (IL); Sur place; USD 42 000 - 62 000; Plein temps

Résumé du poste

WH Wheeling Hospital Inc. is seeking an Insurance Operations Associate to oversee daily activities of insurance and registration staff, ensuring authorization for appointments and procedures.

The role emphasizes training, updates on coverage changes, and accurate billing in the EPIC system. The ideal candidate will have strong communication skills, knowledge of ICD-10/CPT coding, and experience with payor requirements.

Qualifications

• Excellent oral and written communication required.
• Basic knowledge of medical terminology.
• Basic knowledge of ICD-10 and CPT coding.
• Basic knowledge of third party payors and insurance processes.
• Strong math skills for billing and collection.
• Familiarity with time of service collection procedures.

Responsabilités

• Train new and existing insurance specialists on insurance needs and processes in clinical offices.
• Provide ongoing updates on changes to insurance coverages.
• Identify patients requiring pre-certification or pre-authorization at service time.
• Follow up on accounts based on system flags and authorize services.
• Contact insurance companies to determine eligibility and benefits.
• Explain anticipated self-pay portions to patients and refer to Financial Counselors when needed.
• Utilize EPIC system queues for scheduling, care transitions, and billing edits.
• Assist in denial management and appeal denials based on medical necessity.

Connaissances

Oral and written communication

Medical terminology

ICD-10 and CPT coding

Third party payors

Business math

Time of service collection

Customer service

Typing speed 25 wpm

Formation

High school diploma or equivalent

Description du poste

WH Wheeling Hospital Inc. is seeking an Insurance Operations Associate to oversee daily activities of insurance and registration staff, ensuring authorization for appointments and procedures.

The role emphasizes training, updates on coverage changes, and accurate billing in the EPIC system. The ideal candidate will have strong communication skills, knowledge of ICD-10/CPT coding, and experience with payor requirements.