Pre-Auth & Benefits Verification Specialist

WVU Medicine; United States; On-site; USD 42,000 - 54,000; Full time

Job summary

WH Wheeling Hospital Inc. is seeking a responsible Insurance Authorization Clerk to ensure all appointments and procedures are pre-authorized and scheduled, verify coverage with insurers, and calculate deductibles and patient balances for front-end collection.

The role focuses on minimizing reimbursement errors from incorrect referral/enrollment details. The candidate should have strong communication skills, basic medical terminology knowledge, and experience with ICD-10/CPT coding and

Qualifications

• High school diploma or equivalent.
• Background check required (state and federal as applicable).
• Previous insurance authorization experience preferred.

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.

Skills

Excellent communication

Medical terminology

ICD-10/CPT knowledge

Third party payors knowledge

Time of service collection

Customer service

Typing 25 wpm

Reading and comprehension

Education

High school diploma or equivalent

Job description

WH Wheeling Hospital Inc. is seeking a responsible Insurance Authorization Clerk to ensure all appointments and procedures are pre-authorized and scheduled, verify coverage with insurers, and calculate deductibles and patient balances for front-end collection.

The role focuses on minimizing reimbursement errors from incorrect referral/enrollment details. The candidate should have strong communication skills, basic medical terminology knowledge, and experience with ICD-10/CPT coding and