Insurance Specialist

WVU Medicine Thomas Hospitals; Charleston (WV); On-site; USD 32,000 - 42,000; Part time

Job summary

THOM Thomas Hospitals is seeking a part-time Insurance Authorization Specialist to ensure all appointments and procedures are pre-authorized, verify coverage, and help minimize reimbursement errors. You’ll work with insurance carriers, patients, and hospital departments to obtain eligibility and financial clearance.

The role requires a high school diploma and prior insurance authorization experience, with strong communication skills and proficiency in EPIC systems.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal (if applicable).
• Previous insurance authorization experience.

Responsibilities

• Identify patients needing pre-certification or pre-authorization at the time services are requested or notified by another department.
• Follow up on accounts as indicated by system flags.
• Contact insurance companies or employers to determine eligibility and benefits for requested services.
• Follow up with patient or insurer to resolve coverage issues for financial clearance.
• Use EPIC work queues for scheduling, transition of care, and billing edits.
• Perform medical necessity screening as required by third party payors.
• Document referrals/authorization/certification numbers in EPIC.
• Initiate charge anticipation calculations for anticipated self-pay portions.
• Explain anticipated self-pay amounts to patients; refer to Financial Counselors as needed.
• Assist in denial management and appeal denials based on medical necessity.

Skills

Communication

Medical terminology

ICD-10/CPT coding

Customer service

Typing speed 25 wpm

Education

High school diploma or equivalent

Job description

Company

THOM Thomas Hospitals

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

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

Experience

• 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

• 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

• 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

24

Shift

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.