Insurance Specialist
WVU Medicine
Ruby
Insurance Specialist – Rehab Services
WVU Medicine
full-time
Posted on:
Location Type: Remote
Location: Remote • Virginia, West Virginia • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Identify patients requiring pre-certification or pre-authorization when services are requested or notified by other departments.
- Contact insurance carriers or employers to verify eligibility, coverage, benefits, and limitations for requested services.
- Pre-authorize tests and procedures and schedule them accordingly.
- Follow up on accounts indicated by system flags and resolve insurance coverage issues with patients, insurers, or providers.
- Document referrals/authorization/certification numbers and use EPIC work queues for scheduling, transition of care, and billing edits.
- Perform medical necessity screening as required by third-party payors and appeal denials based on medical necessity as needed.
- Initiate charge anticipation calculations and identify anticipated self-pay portions; communicate co-payments/deductibles/co-insurance and account balances to patients.
- Refer self-pay or under-insured patients to in-house Financial Counselors and assess potential public assistance eligibility.
- Assist Patient Financial Services with denial management and appeals; communicate workflow problems to management in a timely manner.
Requirements
- High school diploma or equivalent.
- State criminal background check and Federal (if applicable), as required for regulated areas.
- Previous insurance authorization experience (preferred).
- Experience using EPIC system (work queues, documentation of referrals/authorizations).
- Excellent oral and written communication skills.
- Basic knowledge of medical terminology.
- Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
- General knowledge of time of service collection procedures.
- Excellent customer service and telephone etiquette.
- Minimum typing speed of 25 words per minute.
- Reading and comprehension ability.
- Ability to perform prolonged periods of sitting, clarity of hearing/speaking for extended telephone use, and manual dexterity to operate standard office equipment.
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
insurance authorizationmedical necessity screeningICD-10 codingCPT codingbusiness mathcharge anticipation calculationstime of service collection procedurestyping speed
Soft skills
oral communicationwritten communicationcustomer servicetelephone etiquettereading comprehension
Certifications
high school diploma
