Insurance Authorization Specialist I

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full.  Below, you’ll find other important information about this position. 

This position is responsible for ensuring that the correct insurance and authorization information is recorded in the referral or auth/cert. Ensures services scheduled by both internal and outside providers have approved authorization as required by payer and procedure prior to service. Reaching out to internal clinics or outside physicians to obtain the required information if missing or incorrect. Escalates financial clearance risks as appropriate in compliance with the Financial Clearance Program. The verification of authorization information is needed for accurate billing and to ensure maximum reimbursement of services provided.

MINIMUM QUALIFICATIONS:

EDUCATION AND EXPERIENCE

1. High School diploma or equivalent.

PREFERRED QUALIFICATIONS:

EDUCATION AND EXPERIENCE

1. 1 - 2 years’ experience working in a medical environment (such as a hospital, doctor's office, or ambulatory clinic).

2. Understanding of authorization processes, insurance guidelines, and third-party payors practices. 3. Must be proficient in Microsoft Office applications. Excellent communication and interpersonal skills.

4. Ability to prioritize and multitask a large work volume with high level of efficiency and attention to detail.

CORE DUTIES AND RESPONSIBILITIES: As an advocate for WVUH/UHA employees, company and departmental goals and initiatives and HR Compliance, demonstrate knowledge of management and employee needs and apply that knowledge to create solutions.

1.  Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.

2. Contacts insurance company or employer to determine eligibility and benefits for requested services.

3. Use work queues within the EPIC system for maintaining authorization for referrals and surgeries.

4. Ensures accurate coding of the diagnosis, procedure, and facility align with authorization obtained.

5.  Provides authorization verification of services timely to avoid unnecessary delays in treatment and reduce excessive nonclinical administrative time required of providers.

6. Utilize payor resources and any other applicable reference material to verify accurate prior authorization

7. Notifies scheduling and physicians of any cases not authorized.

8. Excellent time management and organization with time sensitive work.

9. Maintains compliance with departmental quality standards and productivity measures.

10. Works collaboratively and politely with internal and external contacts specifically Physicians, Financial Clearance/Counselor, Schedulers, and Nurses.

11. Uses hospital communications systems (fax, pagers, telephones, copiers, scanners, and computers) in accordance with hospital standards.

12. Maintain in baskets in Epic and emails in Outlook.

13. Participate in monthly team meetings and one-on-ones.

14. Follows established workflows, identifies deviations or deficiencies in standards/systems/processes and communicates problems to supervisor or manager.

15. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information.

SKILLS AND ABILITIES:

1. Excellent oral and written communication skills.

2. Practical knowledge of medical terminology.

3. Practical knowledge of ICD-10 and CPT coding.

4. Practical knowledge of third-party payors.

5. General knowledge of time-of-service collection procedures.

6. Excellent customer service and telephone etiquette.

7. Minimum typing speed of 25 words per minute.

8. Excellent reading and comprehension ability.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

536 SYSTEM Hospital Authorization Unit