Pre-Authorization & Insurance Billing Specialist

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

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.