Pre-Auth & Insurance Coverage Specialist

WVU Medicine

Bridgeport, Northern (WV, KY)

Hybrid

USD 36,000 - 48,000

Part time

14 days+

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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.