Insurance Specialist (Adeniyi)

WVU Medicine; United States; On-site; USD 33,000 - 48,000; Full time

Job summary

UHC United Hospital Center in Bridgeport, WV, seeks an Insurance Authorization Specialist to verify coverage, obtain pre-certifications, and schedule tests and procedures using the EPIC system.

The role focuses on communicating anticipated patient financial responsibilities, resolving coverage issues with carriers, and supporting front-end collection processes in a 40-hour day-shift, non-exempt environment.

Qualifications

• High school diploma or equivalent required.
• Background check as required for regulated areas.

Responsibilities

• Pre-certification/pre-authorization identification at service requests or upon notification.
• Follow up on accounts flagged by the system.
• Contact insurance carriers to determine eligibility and benefits for requested services.
• Address coverage issues with patients/insurers to obtain financial resolution.
• Use EPIC work queues for scheduling, care transitions, and billing edits.
• Perform medical necessity screening as required by payors.
• Document referrals/authorization/certification numbers in EPIC.
• Initiate charge anticipation calculations and identify anticipated self-pay portions.
• Explain anticipated self-pay, co-pays, deductibles, and balances to patients; refer to Financial Counselors when needed.
• Assist with denial management and appeals based on medical necessity.
• Communicate workflow problems to management promptly.
• Assess self-pay patients for public assistance and provide financial counseling information.

Skills

Excellent oral and written comms

Medical terminology

ICD-10 & CPT coding

Time-of-service collection

Customer service & telephone etiquette

Typing speed 25 wpm

Reading/comprehension

Education

High school diploma or equivalent

Background check (state & federal)

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:

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:

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.