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.
- 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.
- 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 by utilizing insurance portals, prior authorization forms, or calling insurances.
- 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.
- Uses hospital communications systems (fax, pagers, telephones, copiers, scanners, and computers) in accordance with hospital standards.
- Daily follow up on submitted authorization requests.
- Scheduling and following up on peer to peers.
- Submitting and following up with prior authorization appeals for denied medications.
- Clearly and effectively communicate to the appropriate persons when home infusion or pharmacy benefit is needed.
- Verification of referrals and authorizations in work queues.
- Identify changes in medication dosing/frequency.
- Assists Patient Financial Services with denial management issues and will obtain retro authorizations as needed.
- Maintain in baskets in Epic and emails in Outlook.
- Participate in monthly team meetings and one-on-ones.
- Builds admissions and submit authorization for elective inpatient chemotherapy admission and observations.
- Follows established workflows, identifies deviations or deficiencies in standards/systems/processes and communicates problems to supervisor or manager.
- Is polite and respectful when communicating with staff, physicians, patients, and families. Approaches interpersonal relations in a positive manner.
- Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information.
Requirements
- High school graduate or equivalent with 2 years working experience in a medical environment, (such as a hospital, doctor’s office, or ambulatory clinic.)
- Associate’s degree and 1 year of experience in a medical environment.
Nice to Have
- 3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes.
- Understanding of authorization processes, insurance guidelines, and third-party payors 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.
Work Arrangement
On-site
Additional Information
- Scheduled Weekly Hours: 40
- Shift: null
- Exempt/Non-Exempt: Non-Exempt
- Company: SYSTEM West Virginia University Health System
- Cost Center: 536 SYSTEM Hospital Authorization Unit
