Insurance Specialist

WVU Medicine; Bridgeport (WV); On-site; USD 36,000 - 48,000; Full time

Job summary

West Virginia University Health System in Bridgeport, WV seeks a team member to ensure proper pre-certification and pre-authorization for services, verify coverage with insurers, and schedule tests. The role minimizes reimbursement errors by accurate referral/enrollment data and uses EPIC for billing and scheduling.

Strong communication and basic ICD-10/CPT knowledge are required. High school diploma and background check are required.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal checks as required.
• Knowledge of ICD-10 and CPT coding is preferred or required.
• Excellent oral and written communication skills and customer service.

Responsibilities

• Identify patients needing pre-certification or pre-authorization when services are requested.
• Follow up on accounts flagged by the system.
• Contact insurance companies to determine eligibility and benefits.
• Inform patients about anticipated self-pay portions and resolve coverage issues.
• Use EPIC work queues for scheduling, transition of care, and billing edits.
• Perform medical necessity screening as required by payors.
• Document referrals and authorization numbers in EPIC.
• Initiate charge anticipation calculations for anticipated self-pay portions.
• Communicate self-pay amounts to patients and refer to Financial Counselors as needed.
• Assist with denial management and appeals when required.
• Report workflow problems to management.
• Assess self-pay patients for public assistance and provide financial counseling information.

Skills

Excellent communication

Written communication

Customer service

Telephone etiquette

Reading comprehension

Typing speed 25 wpm

Education

High school diploma or equivalent

Tools

EPIC system

Job description

Welcome! We’re excited you’re considering an opportunity with us!

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:

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

PREFERRED QUALIFICATIONS

1. Previous insurance authorization experience.

CORE DUTIES AND RESPONSIBILITIES:

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:

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:

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: 40 Shift: Day (United States of America) Exempt/Non-Exempt: United States of America (Non-Exempt) Company: UHC United Hospital Center Cost Center: 69 UHC Rheumatology Address: 327 Medical Park Drive Bridgeport 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.

The West Virginia University Health System is West Virginia’s largest health system and largest private employer, providing care to communities across West Virginia, Maryland, Ohio, and Pennsylvania. The integrated academic health system includes 25 hospitals and five institutes, with more than 3,500 licensed beds, 4,000 clinicians, 39,000 employees, and $8.5 billion in annual operating revenues. Anchoring the system in Morgantown, West Virginia, are WVU Hospitals, an 880-bed academic medical center, and the 150-bed WVU Medicine Golisano Children’s Hospital. Together, the Health System’s hospitals, clinics, and specialty programs provide a comprehensive continuum of care, ranging from community-based primary and specialty services to highly complex, quaternary care and post-acute care.