Pre-Authorization & Insurance Verification Specialist

Wheeling Hospital; Wheeling (WV); On-site; USD 36,000 - 48,000; Full time

Job summary

Wheeling Hospital is seeking an Insurance Authorization Specialist to verify coverage, obtain pre-authorization for tests and procedures, and schedule services. You will communicate anticipated patient liabilities and coordinate with insurance carriers to minimize reimbursement errors.

In this role, you will use the EPIC system, follow up on accounts, determine eligibility, and assist with denial management as needed, ensuring accurate referrals and timely financial counseling for patients.

Qualifications

• High school diploma or equivalent.
• State or federal background check as required for regulated areas.
• Excellent oral and written communication skills.
• Basic knowledge of medical terminology.
• Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
• General knowledge of time of service collection procedures.
• Excellent customer service and telephone etiquette.
• Minimum typing speed of 25 words per minute.
• Reading and comprehension ability.

Responsibilities

• Identifies patients requiring pre-certification or pre-authorization when services are requested or notified by hospital staff.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Addresses insurance coverage issues with patients and providers to obtain financial resolution.
• Uses EPIC work queues for scheduling, transitions of care, and billing edits.
• Performs medical necessity screening as required by third party payors.
• Documents referrals/authorization/certification numbers in EPIC.
• Initiates charge anticipation calculations and identifies anticipated self-pay portions.
• Communicates anticipated self-pay amounts and refers to Financial Counselors as needed.
• Assists with denial management and may appeal denials based on medical necessity.
• Escalates workflow problems to management promptly.
• Assesses self-pay patients for public assistance and provides financial counseling information.

Skills

Oral and written communication

Medical terminology

ICD-10 and CPT coding

Time of service collection

Customer service

Typing speed 25 wpm

Reading comprehension

Education

High school diploma or equivalent

Background check (state and federal)

Job description

Wheeling Hospital is seeking an Insurance Authorization Specialist to verify coverage, obtain pre-authorization for tests and procedures, and schedule services. You will communicate anticipated patient liabilities and coordinate with insurance carriers to minimize reimbursement errors.

In this role, you will use the EPIC system, follow up on accounts, determine eligibility, and assist with denial management as needed, ensuring accurate referrals and timely financial counseling for patients.