Insurance Specialist (Adeniyi)

United Hospital Center; Bridgeport (WV); On-site; USD 38,000 - 48,000; Full time

Job summary

United Hospital Center in Bridgeport, West Virginia, seeks an Insurance Authorization Specialist to verify coverage, arrange pre-certifications, and schedule procedures. The role emphasizes accurate patient billing information and minimizing reimbursement errors.

You will use EPIC to document authorizations, determine patient responsibility, and coordinate with Financial Counselors for complex cases. Strong communication skills and knowledge of ICD-10/CPT coding are essential.

Qualifications

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

Responsibilities

• Identify patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follow up on accounts as indicated by system flags.
• Contact insurance company or employer to determine eligibility and benefits for requested services.
• Follow 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.

Skills

Excellent communication

Medical terminology

ICD-10/CPT coding

Time of service collections

Customer service

Typing speed 25 wpm

Reading comprehension

Education

High school diploma

Tools

EPIC system

Job description

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

• 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

40

Shift

Day (United States of America)

Exempt/Non-Exempt

United States of America (Non-Exempt)

Company

UHC United Hospital Center

Cost Center

8963 UHC Vascular Surgery Physician Office Building

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.