West Virginia University Health System is hiring an Insurance Specialist III to be responsible for obtaining authorizations for elective infusions and injections. This role is crucial for financially clearing patients and ensuring reimbursement for the organization, acting as a liaison between clinical teams and pharmacists to communicate effectively regarding infusion prior authorization issues.
What You'll Do
- Utilize work queues within the EPIC system to manage workloads and prioritize to meet deadlines.
- Collect and communicate outpatient benefit information to the Patient Financial Services team via queues and billing indicators in Epic.
- Refer to medical and coverage policies for medications and research CPT codes for drugs/injections.
- Verify authorization requirements by utilizing insurance portals or calling insurances.
- Submit authorizations as a buy-and-bill via medical benefit for outpatient on-campus hospital requests.
- Review and interpret medical record documentation to answer clinical questions during the authorization process.
- Clearly and effectively communicate with clinics when additional information is needed.
- Use hospital communications systems, including fax, pagers, telephones, copiers, scanners, and computers, in accordance with hospital standards.
- Perform daily follow-up on submitted authorization requests.
- Schedule and follow up on peer-to-peers.
- Submit and follow up with prior authorization appeals for denied medications.
- Communicate clearly and effectively when home infusion or pharmacy benefit is needed.
- Verify referrals and authorizations in work queues and identify changes in medication dosing/frequency.
- Assist Patient Financial Services with denial management issues and obtain retro authorizations as needed.
- Maintain in baskets in Epic and emails in Outlook.
- Participate in monthly team meetings and one-on-ones.
- Build admissions and submit authorization for elective inpatient chemotherapy admission and observations.
- Follow established workflows, identify deviations or deficiencies in standards/systems/processes, and communicate problems to supervisor or manager.
- Maintain a polite and respectful demeanor when communicating with staff, physicians, patients, and families.
- Maintain confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic, clinical, and financial information.
What We're Looking For
- High school graduate or equivalent with 2 years working experience in a medical environment (such as a hospital, doctor’s office, or ambulatory clinic).
- OR an Associate’s degree and 1 year of experience in a medical environment.
Nice to Have
- 3 years of experience with knowledge and interpretation of medical terminology, ICD-10, and CPT codes.
- Understanding of authorization processes, insurance guidelines, and third-party payor practices.
- Proficiency in Microsoft Office applications.
- Excellent communication and interpersonal skills.
- Ability to prioritize to meet deadlines and multitask a large work volume with a high level of efficiency and attention to detail.
- Basic computer skills.
Technical Stack
- EPIC system
- Microsoft Office applications
- Outlook
Team & Environment
This position reports to a supervisor or manager.
Work Mode
This role is onsite.
West Virginia University Health System is an equal opportunity employer.
