Team Lead Insurance Specialist Patient Access

WVU Medicine

83d

About The Position

The role serves as the initial point of contact for inquiries related to Insurance Authorization Specialist responsibilities. It involves overseeing daily operations to ensure timely acquisition of required prior authorizations. Collaborates closely with the Hospital Authorization Unit’s leadership team to implement and maintain efficient processes. Works in tandem with the denials management team to identify areas for improvement, aiming to reduce denials and increase revenue. Additionally, continues to actively perform the duties and responsibilities associated with being an Insurance Authorization Specialist within the Hospital Authorization Unit.

Requirements

• High school graduate or equivalent with 3-4 years working experience in a medical environment, or an Associate’s degree and 2 years of experience in a medical environment required.

Nice To Haves

• 3-4 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 people skills.
• Ability to prioritize to meet deadlines and multitask a large work volume with an elevated level of efficiency and attention to detail.
• Basic computer skills.

Responsibilities

• Reviews Hospital Authorization Unit’s denials, trend denials, work with Hospital Authorization Unit’s leadership team to identify and implement process improvements.
• Attends Hospital Authorization Unit’s related meetings as an insurance authorization specialist representative, giving valuable input for process improvements.
• Works closely with the Hospital Authorization Unit management team and all staff within the department.
• Serves as first point of contact for questions from co-workers and members of the Hospital Authorization Unit’s team.
• Collaborates closely with the Hospital Authorization Unit management team and trainer on creating and maintaining a current insurance specialist training guide.
• Responsible for allocating daily workload among team members based on volume and priority levels.
• Provides training, coaches, and mentors all Hospital Authorization Unit’s insurance authorization specialist staff.
• Ensures that all patient visits and procedures are authorized prior to services are rendered.
• If services are denied by the payor, ensures that information is communicated to appropriate clinical and support staff.
• Listens to team members’ feedback and resolves any issues or conflicts.
• Informs leadership team of any issues or concerns that arise.
• Acts as point of contact for clinical nursing teams to problem solve emergent cases.
• Reviews work performed by Hospital Authorization Unit’s insurance specialists’ staff to ensure accuracy and compliance with established guidelines.
• Creates an inspiring environment and fosters an open communication culture.
• Sets clear goals for the team.
• Delegates tasks to staff as appropriate and sets deadlines.
• Monitors team performance and reports on metrics to department leadership.
• Motivates and provides support for team members.
• Recognizes team members who exceed expectations and high-performing staff for their accomplishments.
• Encourages creativity and efficiency amongst the team.
• Suggests and organizes team building activities for the group.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees