Insurance Authorization Specialist I

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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:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: