Insurance Specialist
WVU Medicine
Ruby
Insurance Authorization Specialist II
WVU Medicine
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Junior
Tech Stack
Ruby
About the role
- Obtain authorizations for elective procedures, referrals, tests, and surgeries; verify prior authorization requirements using payor resources and medical policies.
- Code cases and review clinical documentation to ensure documentation is complete and diagnosis/procedure/facility coding align with authorization obtained.
- Use EPIC work queues to obtain and follow up on authorizations; maintain in-baskets in Epic and emails in Outlook; provide timely authorization verification to avoid treatment delays.
- Schedule and follow up on peer-to-peer reviews and denials; submit and follow up on prior authorization appeals and obtain retro-authorizations as needed.
- Assist Patient Financial Services with denial management and escalate financial clearance risks in compliance with the Financial Clearance Program.
- Notify scheduling and physicians of any cases not authorized within department policy; maintain compliance with departmental quality standards and productivity measures.
- Work collaboratively and politely with physicians, schedulers, nurses, financial clearance/counselors, and other internal/external contacts; maintain confidentiality.
- Use hospital communications systems (fax, telephone, copiers, scanners, computers); perform prolonged periods of sitting and extended telephone work.
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.
- 3 years’ experience and knowledge/interpretation of medical terminology, ICD-10, and CPT codes.
- Understanding of authorization processes, insurance guidelines, and third-party payors.
- Proficiency in Microsoft Office applications; basic computer skills.
- Excellent oral and written communication and interpersonal skills.
- Ability to prioritize, meet deadlines, multitask a large work volume with a high level of efficiency and attention to detail.
- Practical knowledge of time-of-service collection procedures and basic business math.
- Excellent customer service and telephone etiquette; minimum typing speed of 25 words per minute.
- Excellent reading and comprehension ability.
