Insurance Specialist

WVU Medicine•Bensley, VA

37d

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 records information in the system for front-end collection. The position helps minimize reimbursement errors caused by inaccurate referral and enrollment information. The Insurance Specialist identifies services requiring pre-certification or pre-authorization, verifies eligibility and benefits, performs medical-necessity screening as required by payors, and documents referral and authorization information in EPIC. The role communicates anticipated patient costs, refers patients with limited or exhausted benefits to Financial Counselors, and supports denial management, including appeals based on medical necessity when needed. The position also assesses self-pay patients for potential public assistance and provides financial counseling information to self-pay and under-insured patients.

Requirements

High school diploma or equivalent.
State criminal background check and Federal 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 and authorization or certification numbers in EPIC.
Initiate charge anticipation calculations and accurately identify anticipated charges and self-pay portions.
Communicate anticipated self-pay portions, co-payments, deductibles, co-insurance, and account balances to patients; refer patients with limited or exhausted benefits to in-house Financial Counselors for eligibility assessment.
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 and billing systems.
Provide financial counseling information to self-pay and under-insured patients.
Maintain current knowledge of major payor payment provisions.