Pre-Authorization & Insurance Verification Specialist

WVU Medicine Thomas Hospitals; Charleston (WV); On-site; USD 32,000 - 42,000; Part time

Job summary

THOM Thomas Hospitals is seeking a part-time Insurance Authorization Specialist to ensure all appointments and procedures are pre-authorized, verify coverage, and help minimize reimbursement errors. You’ll work with insurance carriers, patients, and hospital departments to obtain eligibility and financial clearance.

The role requires a high school diploma and prior insurance authorization experience, with strong communication skills and proficiency in EPIC systems.

Qualifications

• High school diploma or equivalent.
• State criminal background check and Federal (if applicable).
• Previous insurance authorization experience.

Responsibilities

• Identify patients needing pre-certification or pre-authorization at the time services are requested or notified by another department.
• Follow up on accounts as indicated by system flags.
• Contact insurance companies or employers to determine eligibility and benefits for requested services.
• Follow up with patient or insurer to resolve coverage issues for financial clearance.
• Use EPIC work queues for scheduling, transition of care, and billing edits.
• Perform medical necessity screening as required by third party payors.
• Document referrals/authorization/certification numbers in EPIC.
• Initiate charge anticipation calculations for anticipated self-pay portions.
• Explain anticipated self-pay amounts to patients; refer to Financial Counselors as needed.
• Assist in denial management and appeal denials based on medical necessity.

Skills

Communication

Medical terminology

ICD-10/CPT coding

Customer service

Typing speed 25 wpm

Education

High school diploma or equivalent

Job description

THOM Thomas Hospitals is seeking a part-time Insurance Authorization Specialist to ensure all appointments and procedures are pre-authorized, verify coverage, and help minimize reimbursement errors. You’ll work with insurance carriers, patients, and hospital departments to obtain eligibility and financial clearance.

The role requires a high school diploma and prior insurance authorization experience, with strong communication skills and proficiency in EPIC systems.