Insurance Specialist

UHC United Hospital Center; Bridgeport (WV); On-site; USD 34,000 - 52,000; Full time

Job summary

UHC United Hospital Center in Bridgeport, WV is seeking a detail-oriented insurance authorization specialist. You will identify patients needing pre-certification, verify coverage with insurers, and communicate self-pay portions to patients, using EPIC for scheduling, billing edits, and care transitions.

Responsibilities include medical necessity screening, documenting referrals, calculating anticipated charges, and assisting with denials and appeals as needed.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal checks as required.
• Knowledge of ICD-10, CPT coding and payor processes.
• Experience with insurance pre-certification/pre-authorization is preferred.
• Strong communication and math skills for patient billing.

Responsibilities

• Identify patients needing pre-certification/pre-authorization.
• Follow up on accounts using system flags.
• Contact insurance or employer to verify eligibility/benefits.
• Explain self-pay portions and arrange financial resolution.
• Use EPIC queues for scheduling, transition of care, billing edits.
• Perform medical necessity screening per payor rules.
• Document referrals/authorization numbers in EPIC.
• Initiate charge anticipation calculations for anticipated charges.
• Communicate anticipated self-pay portions to patients.
• Refer self-pay patients to Financial Counselors for eligibility.
• Assist with denial management and appeals when needed.
• Flag workflow issues to management and resolve promptly.

Skills

Communication

Medical terminology

ICD-10 & CPT coding

Time of service collection

Customer service

Typing speed 25 wpm

Reading & comprehension

Education

High school diploma

Job description

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.This position responsible for assuring all appointments and procedures are authorized. Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection. Responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information.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.1. Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.2. Follows up on accounts as indicated by system flags.3. Contacts insurance company or employer to determine eligibility and benefits for requested services.4. Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.5. Use work queues within the EPIC system for scheduling, transition of care, and billing edits.6. Performs medical necessity screening as required by third party payors.7. Documents referrals/authorization/certification numbers in the EPIC system.8. Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.9. 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.10. Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.11. Communicates problems hindering workflow to management in a timely manner.12. 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: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.1. Prolonged periods of sitting.2. Extended periods on the telephone requiring clarity of hearing and speaking.3. 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.1. Standard office environment.SKILLS AND ABILITIES:1. Excellent oral and written communication skills.2. Basic knowledge of medical terminology.3. Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.4. General knowledge of time of service collection procedures.5. Excellent customer service and telephone etiquette.6. Minimum typing speed of 25 works per minute.7. Must have reading and comprehension ability.Additional Job Description:Scheduled Weekly Hours:40Shift:Exempt/Non-Exempt:United States of America (Non-Exempt)Company:UHC United Hospital CenterCost Center:121 UHC HVI BridgeportAddress:527 Medical Park DriveBridgeportWest VirginiaEqual Opportunity EmployerWest 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.