Senior Pre-Authorization & Medical Coding Specialist

WVU Medicine; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a prioritized Authorization Specialist to obtain pre-certifications for elective procedures, tests, and services. You will verify payer requirements and code accurately to support timely reimbursement and scheduling.

Responsibilities include reviewing medical documentation, communicating with payors, and using EPIC and Outlook to manage authorizations, denials, and denials follow-up while maintaining compliance with departmental standards.

Qualifications

• High school diploma or equivalent with 2 years in a medical environment; or an Associate’s degree with 1 year in a medical setting.
• Experience with medical terminology, ICD-10, and CPT coding is preferred.

Responsibilities

• Identify patients needing pre-certification or pre-authorization at service request or notification.
• Contact insurers to determine eligibility and benefits for requested services.
• Use EPIC work queues to obtain authorizations for referrals, tests, and surgeries.
• Ensure accurate coding of diagnosis, procedure, and facility with authorization.
• Assist denial management and retro-authorization as needed.
• Maintain compliance with departmental quality standards and productivity measures.

Skills

Medical terminology

ICD-10 coding

CPT coding

Authorization processes

Microsoft Office

Communication skills

Multitasking

Basic computer skills

EPIC system

Education

High school diploma or equivalent

Associate’s degree

Tools

EPIC system

Job description

SYSTEM West Virginia University Health System is seeking a prioritized Authorization Specialist to obtain pre-certifications for elective procedures, tests, and services. You will verify payer requirements and code accurately to support timely reimbursement and scheduling.

Responsibilities include reviewing medical documentation, communicating with payors, and using EPIC and Outlook to manage authorizations, denials, and denials follow-up while maintaining compliance with departmental standards.