Insurance Specialist

WVU Medicine•Institute, WI

3d•Onsite

About The Position

This position is responsible for assuring all appointments and procedures are authorized. Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection. The role is responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information. The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer with more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues. The Health System is comprised of 25 hospitals – including J.W. Ruby Memorial Hospital, an 880-bed academic medical center, and the 150-bed WVU Medicine Children’s Hospital in Morgantown, West Virginia – and five institutes.

Requirements

High school diploma or equivalent.
State criminal background check and Federal (if applicable), as required for regulated areas.
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 works per minute.
Must have reading and comprehension ability.

Nice To Haves

Previous insurance authorization experience.

Responsibilities

Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
Follows up on accounts as indicated by system flags.
Contacts insurance company or employer to determine eligibility and benefits for requested services.
Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
Performs medical necessity screening as required by third party payors.
Documents referrals/authorization/certification numbers in the EPIC system.
Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
Communicates problems hindering workflow to management in a timely manner.
Assesses all self-pay patients for potential public assistance through registration/billing systems Provides self-pay/under-insured patients with financial counseling information. Maintains current knowledge of major payor payment provisions.