Insurance Specialist (Adeniyi)

WVU Medicine

20d•Onsite

About The Position

The Insurance Specialist assures that appointments and procedures are authorized. The role contacts insurance carriers to verify coverage and benefit limitations, pre-authorizes and schedules tests and procedures, calculates deductibles, co-payments, account balances, and fees, and documents information in the system for front-end collection. The position helps minimize reimbursement errors caused by inaccurate referral and enrollment information. The specialist identifies patients requiring pre-certification or pre-authorization, verifies eligibility and benefits, follows up on coverage issues, and performs medical-necessity screening when required. The role documents authorization information in EPIC, anticipates charges and self-pay portions, communicates expected costs to patients, assists with denial management and appeals, and connects self-pay or under-insured patients with financial counseling and potential public assistance. This is a 40-hour-per-week, day-shift position in a standard office environment at the UHC Vascular Surgery Physician Office Building in Bridgeport, West Virginia. It is non-exempt.

Requirements

High school diploma or equivalent.
State criminal background check and federal background check, 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 words per minute.
Reading and comprehension ability.

Nice To Haves

Previous insurance authorization experience.

Responsibilities

Identify patients requiring pre-certification or pre-authorization when services are requested or when notified by another hospital or clinic department.
Follow up on accounts as indicated by system flags.
Contact insurance companies or employers to determine eligibility and benefits for requested services.
Follow up with patients, insurance companies, or providers to resolve insurance coverage issues.
Use EPIC work queues for scheduling, transition of care, and billing edits.
Perform medical-necessity screening as required by third-party payors.
Document referrals, authorization numbers, and certification numbers in EPIC.
Initiate charge anticipation calculations and identify anticipated charges and self-pay portions accurately.
Communicate anticipated self-pay portions, co-payments, deductibles, co-insurance, and account balances to patients.
Refer self-pay patients and patients with limited or exhausted benefits to in-house Financial Counselors to determine eligibility.
Assist Patient Financial Services with denial management and appeal denials based on medical necessity as needed.
Communicate workflow-hindering problems to management in a timely manner.
Assess self-pay patients for potential public assistance through registration or billing systems.
Provide self-pay and under-insured patients with financial counseling information.
Maintain current knowledge of major payor payment provisions.