Insurance Authorization Specialist III

WVU Medicine

. This position is responsible for obtaining authorizations for elective infusions and injections to financially clear patients and ensure reimbursement for the organization.

Posted 5/8/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

This position is responsible for obtaining authorizations for elective infusions and injections to financially clear patients and ensure reimbursement for the organization.
Payor resources and any other applicable reference material such as payor and medical policies should be utilized to verify accurate prior authorization requirements.
Escalates financial clearance risks as appropriate in compliance with the Financial Clearance Program.
Serving as a liaison between clinical teams and pharmacists ensuring effective communication regarding infusion prior authorization issues.
Cases are to be coded, and clinical documentation reviewed to ensure the documentation is complete to maximize reimbursement.

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).
Associate’s degree and 1 year of experience in a medical environment.
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 practices.
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

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10CPT codesmedical terminologyauthorization processesinsurance guidelinesthird-party payors practicescodingclinical documentation review

Soft Skills

communicationinterpersonal skillsprioritizationmultitaskingattention to detailefficiency