Insurance Authorization Specialist II

Job not on LinkedIn

🔥 1 minute ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🔒 Insurance

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Obtain authorizations for elective procedures, services, and tests to financially clear patients before services are rendered • Use payor resources, medical policies, and reference materials to verify prior authorization requirements • Code cases and review clinical documentation for completeness • Escalate financial clearance risks in compliance with the Financial Clearance Program • Identify patients requiring pre-certification or pre-authorization • Contact insurance companies or employers to determine eligibility and benefits • Use EPIC work queues to obtain authorizations for referrals, tests, and surgeries within expected timeframes • Follow up on authorization requests, peer-to-peer reviews, denials, and prior authorization appeals • Ensure diagnosis, procedure, and facility coding align with obtained authorization • Verify services promptly to avoid treatment delays and reduce administrative time • Assist Patient Financial Services with denial management and obtain retro-authorizations as needed • Notify scheduling staff and physicians of cases not authorized within department policy • Maintain compliance with quality standards and productivity measures • Collaborate with physicians, financial clearance counselors, schedulers, nurses, patients, families, and other contacts • Maintain EPIC in-baskets and Outlook emails • Participate in monthly team meetings and one-on-ones • Follow established workflows and communicate process or system deficiencies to supervisors or managers • Maintain confidentiality of demographic, clinical, and financial information

🎯 Requirements

• High school graduate or equivalent with 2 years working experience in a medical environment, or an Associate’s degree and 1 year of experience in a medical environment required • 3 years’ experience with medical terminology, ICD-10, and CPT codes • Understanding of authorization processes, insurance guidelines, and third-party payors • Proficiency in Microsoft Office applications • Excellent communication and interpersonal skills • Ability to prioritize deadlines and multitask a large work volume efficiently with attention to detail • Basic computer skills • Practical knowledge of medical terminology, ICD-10 and CPT coding, third-party payors, time-of-service collection procedures, and business math • Minimum typing speed of 25 words per minute • Excellent reading and comprehension ability • Ability to work prolonged periods sitting and extended periods on the telephone • Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment