Insurance Specialist -Temp

WVU Medicine; Bridgeport, Northern (WV, KY); Hybrid; USD 36,000 - 48,000; Part time

Job summary

WVU Medicine is seeking a detail-oriented insurance authorization specialist to ensure pre-certification and pre-authorization for services. You will verify coverage and benefits with insurers, schedule tests, and enter authorization data in EPIC. Strong communication and knowledge of medical terminology are essential.

The role emphasizes accurate self-pay estimates, coordination with patients, and collaboration with Financial Counselors to resolve coverage issues.

Qualifications

• High school diploma or equivalent required.
• Background check and federal checks as required for regulated areas.
• Preferred: previous insurance authorization experience.

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.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Explain to patients the anticipated self-pay portion (co-pays/deductibles) and balance; refer to Financial Counselors as needed.
• Use EPIC work queues for scheduling, transition of care, and billing edits.
• Document referrals/authorization/certification numbers in the EPIC system.
• Assist Patient Financial Services with denial management issues and will appeal denials as needed.

Skills

Excellent communication

Medical terminology knowledge

ICD-10/CPT coding knowledge

Financial counseling understanding

Data entry speed

Education

High school diploma or equivalent

Job description

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: 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: EXPERIENCE:

• Previous insurance authorization experience.

CORE DUTIES AND RESPONSIBILITIES:

• 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:

• 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:

• 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: 4 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: UHC United Hospital Center Cost Center: 68 UHC Orthopaedics 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.

The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer with more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues. The Health System is comprised of 25 hospitals – including J.W. Ruby Memorial Hospital, an 880-bed academic medical center, and the 150-bed WVU Medicine Children’s Hospital in Morgantown, West Virginia – and five institutes.