Insurance Authorization Specialist – III

🔥 59 minutes ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🔒 Insurance

🚫👨‍🎓 No degree required

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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 prior 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 • Serve as liaison between clinical teams and pharmacists regarding infusion prior authorization issues • Code cases and review clinical documentation for completeness and reimbursement optimization • Manage workloads and deadlines using EPIC work queues • Collect and communicate outpatient benefit information to Patient Financial Services • Research CPT codes for drugs and injections • Verify authorization requirements through insurance portals and telephone calls • Submit and follow up on buy-and-bill medical benefit authorizations • Review medical records and answer clinical questions during authorization processes • Communicate with clinics when additional information is needed • Follow up on authorization requests, peer-to-peer reviews, appeals, denied medications, referrals, and retro authorizations • Communicate when home infusion or pharmacy benefits are needed • Identify medication dosing and frequency changes • 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 established workflows and report 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 of work experience in a medical environment, or associate’s degree with 1 year of experience in a medical environment • 3 years’ experience with medical terminology, ICD-10, and CPT codes preferred • Understanding of authorization processes, insurance guidelines, and third-party payor practices preferred • Proficiency in Microsoft Office applications preferred • Excellent communication and interpersonal skills • Ability to prioritize deadlines and multitask a large work volume efficiently with attention to detail • Basic computer skills • Basic knowledge of medical terminology • Basic knowledge of ICD-10 and CPT coding • Basic knowledge of third-party payors • Basic knowledge of 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 • Ability to use EPIC, Outlook, fax machines, pagers, telephones, copiers, scanners, keyboards, and standard office equipment • Prolonged sitting and extended telephone use requiring clear hearing and speaking • Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment • Ability to work in an outpatient clinical environment • Must maintain confidentiality according to policy

🏖️ Benefits

• Full-time schedule of 40 hours per week • Remote work arrangement