Team Lead Insurance Authorization Specialist

WVU Medicine; Core (WV); On-site; USD 42,000 - 54,000; Full time

Job summary

WVU Medicine is seeking an Insurance Authorization Specialist to serve as the initial contact for inquiries. The role ensures timely prior authorizations, collaborates with the Hospital Authorization Unit leadership, and works with the denials management team to reduce denials and improve revenue.

Responsibilities include training staff, allocating workload, and maintaining an up-to-date training guide while ensuring authorizations precede services and communicating payor denials to clinical

Qualifications

• High school diploma or GED with 3-4 years in a medical setting, or an Associate’s degree with 2 years in a medical setting.
• Knowledge of medical terminology, ICD-10, and CPT codes preferred.
• Proficiency in Microsoft Office; good communication and people skills.
• Ability to prioritize, multitask, and maintain accuracy with high volume.

Responsibilities

• Review denials and collaborate with leadership to implement process improvements.
• Attend meetings as the insurance authorization specialist representative and provide input on improvements.
• Allocate daily workload among team members based on volume and priority.
• Provide training, coaching, and mentorship to staff in the Hospital Authorization Unit.

Skills

Communication skills

Microsoft Office

Multitasking

Attention to detail

Medical terminology

Education

High school diploma with 3-4 years medical experience

Associate’s degree with 2 years medical experience

Tools

Microsoft Office

Job description

Welcome! We’re excited you’re considering an opportunity with us! Below, you’ll find other important information about this position.

The role serves as the initial point of contact for inquiries related to Insurance Authorization Specialist responsibilities. It involves overseeing daily operations to ensure timely acquisition of required prior authorizations. Collaborates closely with the Hospital Authorization Unit’s leadership team to implement and maintain efficient processes. Works in tandem with the denials management team to identify areas for improvement, aiming to reduce denials and increase revenue. Additionally, continues to actively perform the duties and responsibilities associated with being and Insurance authorization Specialist within the Hospital Authorization Unit.

Minimum Qualifications

• High school graduate or equivalent with 3-4 years working experience in a medical environment, (such as a hospital, doctor’s office, or ambulatory clinic.)
• OR an Associate’s degree and 2 years of experience in a medical environment required.

Preferred Qualifications

• 3-4 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes.
• Understanding of authorization processes, insurance guidelines, and third-party payors

practices.

• Proficiency in Microsoft Office applications.
• Excellent communication and people skills.
• Ability to prioritize to meet deadlines and multitask a large work volume with an elevated level of efficiency and attention to detail.
• Basic computer skills.

CORE DUTIES AND RESPONSIBILITIES:

• Reviews Hospital Authorization Unit’s denials, trend denials, work with Hospital Authorization Unit’s leadership team to identify and implement process improvements.
• Attends Hospital Authorization Unit’s related meetings as an insurance authorization specialist representative, giving valuable input for process improvements.
• Works closely with the Hospital Authorization Unit management team and all staff within the department.
• Serves as first point of contact for questions from co-workers and members of the Hospital Authorization Unit’s team.
• Collaborates closely with the Hospital Authorization Unit management team and trainer on creating and maintaining a current insurance specialist training guide.
• Responsible for allocating daily workload among team members based on volume and priority levels.
• Provides training, coaches, and mentors all Hospital Authorization Unit’s insurance authorization specialist staff.
• Ensures that all patient visits and procedures are authorized prior to services are rendered. If services are denied by the payor, ensures that information is communicated to appropriate clinical and support staff.
• Listen to team members’ feedback and resolve any issues or conflicts.
• Informs leadership team of any issues or concerns that arise.
• Acts as point of contact for clinical nursing teams to problem solve emergent cases.
• Reviews work performed by Hospital Authorization Unit’s insurance specialists’ staff to ensure accuracy and compliance with established guidelines.
• Creates an inspiring environment and fosters an open communication culture.
• Sets clear goals for the team.
• Delegates tasks to staff as appropriate and sets deadlines.
• Monitors team performance a reports on metrics to department leadership.
• Motivates and provides support for team members.
• Recognizes team members who exceed expectations and high-performing staff for their accomplishments.
• Encourages creativity and efficiency amongst the team.
• Suggests and organizes team building activities for the group.

PHYSICAL REQUIREMENTS:

• Must be able to sit for extended periods of time
• Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment
• Must be able to wear headset for extended periods of time

WORKING ENVIRONMENT:

• Shared office space
• May encounter work interruption from clinical staff requiring immediate attention

Skills And Abilities

• Must be able to handle multiple tasks and direct other’s activities efficiently
• Ability to follow written and oral instruction
• Basic computer skills proficiency
• Familiar with medical terminology

Scheduled Weekly Hours:

40

Exempt/Non-Exempt

Shift

United States of America (Non-Exempt)

Company

SYSTEM West Virginia University Health System

Cost Center

536 SYSTEM Hospital Authorization Unit