Patient Accounts Manager
Soleo Health
Insurance Authorization Specialist III
WVU Medicine
full-time
Posted on:
Origin: • 🇺🇸 United States • Virginia, West Virginia
Visit company websiteJob Level
JuniorMid-Level
Tech Stack
Ruby
About the role
- Obtain prior authorizations for elective outpatient infusions and injections to ensure financial clearance and reimbursement
- Utilize payor resources, medical/coverage policies, and insurance portals to verify authorization requirements
- Serve as liaison between clinical teams and pharmacists regarding infusion prior authorization issues
- Code cases and review clinical documentation to maximize reimbursement
- Use EPIC work queues to manage workloads and communicate outpatient benefit information to Patient Financial Services
- Submit buy-and-bill authorizations, follow up on submitted requests, schedule peer-to-peers and submit appeals for denied medications
- Verify referrals and authorizations, identify medication dosing/frequency changes, and obtain retro authorizations as needed
- Maintain Epic baskets and Outlook emails, participate in team meetings, and follow established workflows
- Maintain confidentiality and professional, respectful communication with staff, physicians, patients, and families
Requirements
- High school graduate or equivalent with 2 years working experience in a medical environment (hospital, doctor’s office, or ambulatory clinic)
- OR Associate’s degree and 1 year of experience in a medical environment
- Preferred: 3 years’ experience with medical terminology, ICD-10, and CPT codes
- Understanding of authorization processes, insurance guidelines, and third-party payor practices
- Proficiency in Microsoft Office applications
- Excellent communication and interpersonal skills
- Ability to prioritize, meet deadlines, and multitask high work volume with attention to detail
- Basic computer skills and minimum typing speed of 25 words per minute
- Basic knowledge of medical terminology, ICD-10 and CPT coding, third-party payors, and business math
- General knowledge of time-of-service collection procedures and excellent customer service/telephone etiquette
