Job details

Insurance Specialist

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This position 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.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent.
2. State criminal background check and Federal (if applicable), as required for regulated areas.

PREFERRED QUALIFICATIONS:

EXPERIENCE:
1. Previous insurance authorization experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

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. Follows up on accounts as indicated by system flags.
3. Contacts insurance company or employer to determine eligibility and benefits for requested services.
4. Follows up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
5. Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
6. Performs medical necessity screening as required by third party payors.
7. Documents referrals/authorization/certification numbers in the EPIC system.
8. Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
9. Communicates with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
10. Assists Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
11. Communicates problems hindering workflow to management in a timely manner.
12. 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.

PHYSICAL REQUIREMENTS: 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.

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

WORKING ENVIRONMENT: 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.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Excellent oral and written communication skills.
2. Basic knowledge of medical terminology.
3. Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
4. General knowledge of time of service collection procedures.
5. Excellent customer service and telephone etiquette.
6. Minimum typing speed of 25 works per minute.
7. Must have reading and comprehension ability.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SRMC Summersville Regional Medical Center

Cost Center:

8319 SRMC Fairview Clinic

Address:

350 Fairview Heights Road

Summersville

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.

Average salary estimate

$45000 / YEARLY (est.)

min

max

$40000K

$50000K

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What You Should Know About Insurance Specialist, WVUMedicine

Join Fairview Health Associates as an Insurance Specialist and become an integral part of a dedicated team committed to providing the best care to our patients. In this role, you'll take charge of ensuring that all appointments and procedures are accurately authorized. Your daily responsibilities will involve contacting insurance carriers to verify coverage, pre-authorizing tests and procedures, and calculating deductibles and co-payments to streamline our front-end collections. With your keen attention to detail, you'll minimize reimbursement errors by ensuring all referral and enrollment information is correct. The ideal candidate will have a high school diploma and preferably some experience in insurance authorization. Your role will encompass identifying patients needing pre-certification, following up on accounts, and assisting patients with their insurance concerns. You'll work with the EPIC system for scheduling and billing edits, performing medical necessity screenings, and providing financial counseling, all while keeping communication open with our patients and their financial needs. We're looking for a team player with exceptional communication skills and a basic knowledge of medical terminology and coding. If you're passionate about helping others and want to thrive in a supportive office environment, we would love to have you join our team at Fairview Health Associates. Your work will directly impact our patients’ access to healthcare, making every day rewarding and fulfilling.

Frequently Asked Questions (FAQs) for Insurance Specialist Role at WVUMedicine

What are the core responsibilities of an Insurance Specialist at Fairview Health Associates?

As an Insurance Specialist at Fairview Health Associates, your main duties include verifying patient insurance coverage, obtaining pre-authorizations for services, and ensuring accuracy in patient account documentation. You will also follow up on denied claims and assist with financial counseling for patients, ensuring they understand their financial obligations related to healthcare services.