Insurance Authorization Specialist III

🔥 7 minutes ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🔒 Insurance

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 infusions and injections to financially clear patients and ensure reimbursement • Use payor resources and medical policies to verify prior authorization requirements • Escalate financial clearance risks in compliance with the Financial Clearance Program • Liaise between clinical teams and pharmacists regarding infusion prior authorization issues • Code cases and review clinical documentation for completeness and maximum reimbursement • Manage workloads and prioritize deadlines using EPIC work queues • Collect and communicate outpatient benefit information to Patient Financial Services through Epic queues and billing indicators • Refer to medical and coverage policies for medications and research CPT codes for drugs/injections • Verify and submit authorizations through insurance portals, forms, or calls • Review medical records to answer clinical authorization questions • Communicate with clinics when additional information is needed • Follow up on authorization requests, peer-to-peer reviews, and prior authorization appeals • Communicate when home infusion or pharmacy benefits are needed • Verify referrals and authorizations in work queues and identify medication dosing/frequency changes • Assist with denial management and obtain retro authorizations • Maintain Epic in baskets and Outlook emails • Participate in monthly team meetings and one-on-ones • Build admissions and submit authorizations for elective inpatient chemotherapy admissions and observations • Follow workflows, report process deficiencies, maintain confidentiality, and communicate respectfully with staff, physicians, patients, families, and the public

🎯 Requirements

• High school graduate or equivalent with 2 years working experience in a medical environment, or Associate’s degree and 1 year of experience in a medical environment • 3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes (preferred) • Understanding of authorization processes, insurance guidelines, and third-party payors practices • Proficiency in Microsoft Office applications • Excellent communication and interpersonal skills • Ability to prioritize to meet deadlines and multitask a large work volume with efficiency and attention to detail • Basic computer skills • Minimum typing speed of 25 words per minute • Reading and comprehension ability • Ability to work in an outpatient clinical environment • United States of America work environment