Pre-Authorization & Insurance Specialist

United Hospital Center; Bridgeport (WV); On-site; USD 5,158,000 - 6,304,000; Part time

Job summary

United Hospital Center in Bridgeport, WV is seeking an Insurance Verification/Financial Counselor to support pre-certification processes and patient billing for services.

The role requires strong communication, knowledge of ICD-10/CPT basics, and ability to use EPIC for referrals and billing notes; 4 hours weekly, non-exempt, in-office environment.

You will work with patients and insurers to determine eligibility, explain anticipated charges, and connect to Financial Counselors when needed.

Qualifications

• High school diploma or equivalent.
• Background check requirement as applicable for regulated areas.

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 (basic)

ICD-10/CPT knowledge

Billing and payor knowledge

Customer service

Typing speed 25 wpm

Reading and comprehension

Education

High school diploma or equivalent

Background check requirements

Job description

United Hospital Center in Bridgeport, WV is seeking an Insurance Verification/Financial Counselor to support pre-certification processes and patient billing for services.

The role requires strong communication, knowledge of ICD-10/CPT basics, and ability to use EPIC for referrals and billing notes; 4 hours weekly, non-exempt, in-office environment.

You will work with patients and insurers to determine eligibility, explain anticipated charges, and connect to Financial Counselors when needed.