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Insurance Authorization Specialist II
WVU Medicine. Responsible for obtaining authorizations for elective procedures, services, and tests.
About the role
Key responsibilities & impact- Responsible for obtaining authorizations for elective procedures, services, and tests
- Utilize payor resources and any other applicable reference material to verify accurate prior authorization requirements
- Cases are to be coded, and clinical documentation reviewed to ensure completeness
- Escalates financial clearance risks as appropriate
- Identifies patients requiring pre-certification or pre-authorization at the time services are requested
- Contacts insurance company or employer to determine eligibility and benefits for requested services
- Use work queues within the EPIC system for obtaining authorization for referrals, tests, and surgeries
- Follows up on submitted authorization requests timely
- Provides authorization verification of services timely
- Schedules and follows up on peer to peers and denials
- Assists Patient Financial Services with denial management issues
- Maintains compliance with departmental quality standards and productivity measures
- Works collaboratively and politely with internal and external contacts.
Requirements
What you’ll need- High school graduate or equivalent with 2 years working experience in a medical environment, (such as a hospital, doctor’s office, or ambulatory clinic.) OR
- Associate’s degree and 1 year of experience in a medical environment required.
- 3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes.
- Understanding of authorization processes, insurance guidelines, and third-party payors
- Proficiency in Microsoft Office applications.
- Excellent communication and interpersonal skills.
- Ability to prioritize to meet deadlines and multitask a large work volume with a high level of efficiency and attention to detail.
- Basic computer skills.
Benefits
Comp & perks- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10CPT codesauthorization processesmedical terminologyprior authorizationcodingdenial managementfinancial clearancecomplianceMicrosoft Office
Soft Skills
communicationinterpersonal skillsattention to detailmultitaskingprioritizationcollaborationefficiencyproblem-solvingcustomer servicetimeliness