Insurance Specialist

Overview

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• This position is responsible for assuring all appointments and procedures are authorized. Insurance carriers are contacted to verify coverage and benefit limitations, tests and procedures are pre-authorized and scheduled, deductibles, co-payments, account balances, and fees are calculated and notations are added to the system for front end collection. Responsible for minimizing reimbursement errors resulting from inaccuracy of referral and enrollment information.
• Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follows up on accounts as indicated by system flags.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
• Uses work queues within the EPIC system for scheduling, transition of care, and billing edits.
• Performs medical necessity screening as required by third party payors.
• Documents referrals/authorization/certification numbers in the EPIC system.
• Initiates charge anticipation calculations and accurately identifies anticipated charges to determine anticipated self-pay portions.
• Communicates with the patient the anticipated self-pay portion (co-payments/deductibles/co-insurance) and account balance; refers self-pay patients to in-house Financial Counselors to determine eligibility.
• Assists Patient Financial Services with denial management issues and may appeal denials based on medical necessity as needed.
• Communicates problems hindering workflow to management in a timely manner.
• Assesses all self-pay patients for potential public assistance through registration/billing systems; provides self-pay/under-insured patients with financial counseling information; maintains current knowledge of major payor payment provisions.

• Education, Certification, and/or Licensure: High school diploma or equivalent;
  State criminal background check and Federal (if applicable), as required for regulated areas.
• Experience: Previous insurance authorization experience (preferred).

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Prolonged periods of sitting.
• Extended periods on the telephone requiring clarity of hearing and speaking.
• Manual dexterity required to operate standard office equipment.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standard office environment.

• 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.

At times may be required to travel between WVU clinics.

• Scheduled Weekly
  
  Hours:
  
  40
• Exempt/Non-Exempt:
  Non-Exempt
• Shift: United States of America (Non-Exempt)
• Company: UNTWN Uniontown Hospital
• Cost Center: 506 UNTWN Unassigned
• Address: 224 Memorial Boulevard, Connellsville, Pennsylvania

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair…