Insurance Specialist-Department of Medicine

Wheeling Hospital; Wheeling (WV); On-site; USD 36,000 - 48,000; Full time

Job summary

Wheeling Hospital is seeking an Insurance Authorization Specialist to verify coverage, obtain pre-authorization for tests and procedures, and schedule services. You will communicate anticipated patient liabilities and coordinate with insurance carriers to minimize reimbursement errors.

In this role, you will use the EPIC system, follow up on accounts, determine eligibility, and assist with denial management as needed, ensuring accurate referrals and timely financial counseling for patients.

Qualifications

• High school diploma or equivalent.
• State or federal background check as required for regulated areas.
• 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 words per minute.
• Reading and comprehension ability.

Responsibilities

• Identifies patients requiring pre-certification or pre-authorization when services are requested or notified by hospital staff.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Addresses insurance coverage issues with patients and providers to obtain financial resolution.
• Uses EPIC work queues for scheduling, transitions of care, and billing edits.
• Performs medical necessity screening as required by third party payors.
• Documents referrals/authorization/certification numbers in EPIC.
• Initiates charge anticipation calculations and identifies anticipated self-pay portions.
• Communicates anticipated self-pay amounts and refers to Financial Counselors as needed.
• Assists with denial management and may appeal denials based on medical necessity.
• Escalates workflow problems to management promptly.
• Assesses self-pay patients for public assistance and provides financial counseling information.

Skills

Oral and written communication

Medical terminology

ICD-10 and CPT coding

Time of service collection

Customer service

Typing speed 25 wpm

Reading comprehension

Education

High school diploma or equivalent

Background check (state and federal)

Job description

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

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

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

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.

Scheduled Weekly Hours:

36

Shift:

United States of America (Non-Exempt)

Company

WH Wheeling Hospital Inc.

Cost Center

8067 WH Medicine Infectious Diseases

Address

1 Medical Park Drive
Wheeling
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.