Insurance Specialist

United Hospital Center; Bridgeport (WV); On-site; USD 32,000 - 42,000; Full time

Job summary

United Hospital Center is seeking a Cost Center professional to ensure all appointments and procedures are authorized and verified with insurance carriers. The role includes calculating self-pay portions, following up on denials, and documenting authorizations in EPIC.

The position emphasizes strong communication, accurate billing, and knowledge of ICD-10/CPT coding to minimize reimbursement errors and improve front-end collections.

Qualifications

• High school diploma or equivalent.
• State and federal background checks as required for regulated areas.
• Previous insurance authorization experience preferred.

Responsibilities

• Identifies patients needing pre-certification or pre-authorization at time of service request.
• Follows up on accounts flagged by the system.
• Contacts insurance companies to determine eligibility and benefits for requested services.
• Assists in resolving insurance coverage issues to secure financial clearance.
• Uses EPIC queues for scheduling, care transition, and billing edits.
• Performs medical necessity screening per third-party payors.
• Documents referrals/authorization/certification numbers in EPIC.
• Calculates anticipated charges and communicates self-pay portions to patients.

Skills

Communication skills

Medical terminology

ICD-10/CPT coding

Billing and math

Customer service

Typing 25 wpm

Reading/comprehension

Education

High school diploma or equivalent

Tools

EPIC system

Job description

Cost Center

121 UHC HVI Bridgeport

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

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

Experience

Preferred Qualifications

• 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.
• Assess 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.

• 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

• 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

40

Exempt/Non-Exempt

Shift

United States of America (Non-Exempt)

Company

UHC United Hospital Center

Cost Center

121 UHC HVI Bridgeport

Address

527 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.