Insurance Specialist

WVU Medicine; Arkansas; On-site; USD 38,000 - 62,000; Full time

Job summary

THOM Thomas Hospitals in Charleston, West Virginia, is seeking a Patient Financial Services Assistant to manage pre-certification, verify insurance eligibility, and explain anticipated patient costs for services. The role includes follow-up on accounts, denials management with insurers, communicating self-pay obligations to patients, and recording approvals in the EPIC system.

Recent experience in medical billing or insurance authorization is preferred, with strong communication and basic math

Qualifications

• High school diploma or equivalent required.
• State criminal background check and Federal check as required for regulated areas.

Responsibilities

• Identifies patients needing pre-certification or pre-authorization at service request or notification.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Explanation of anticipated self-pay portions to patients including co-pays and deductibles.
• Uses EPIC system queues for scheduling, transition of care, and billing edits.
• Performs medical necessity screening as required by third party payors.
• Documents referrals/authorization/certification numbers in EPIC.
• Manages denial issues and assists with appeals based on medical necessity.
• Coordinates with management to communicate workflow problems and improve processes.
• Assesses self-pay patients for public assistance opportunities and provides financial counseling information.

Skills

Insurance authorization experience

Communication

Customer service

Typing

Education

High school diploma

Tools

EPIC system

Job description

MINIMUM QUALIFICATIONS

EDUCATION, CERTIFICATION, AND/OR LICENSURE

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

PREFERRED QUALIFICATIONS

EXPERIENCE

1. Previous insurance authorization experience.

CORE DUTIES AND RESPONSIBILITIES

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• 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.
• Assesses 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.

PHYSICAL REQUIREMENTS

Following are the physical demands described for this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Prolonged periods of sitting.
• Extended periods on the telephone requiring clarity of hearing and speaking.
• Manual dexterity required to operate standard office equipment.

WORKING ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standard office environment.

SKILLS AND ABILITIES

Following are the required skills and abilities for this position:

• Excellent oral and written communication skills.
• Basic knowledge of medical terminology.
• Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
• General knowledge of time of service collection procedures.
• Excellent customer service and telephone etiquette.
• Minimum typing speed of 25 works per minute.
• Must have reading and comprehension ability.

Additional Job Description

Scheduled Weekly Hours: 24

Shift:

Exempt/Non-Exempt: United States of America (Non-Exempt)

Company: THOM Thomas Hospitals

Cost Center: 6187 THOM Cardiology South Charleston

Address: 4315 MacCorkle Avenue SE
Charleston
West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.