Insurance Specialist - General Surgery Department

Overview

Insurance Specialist - General Surgery Department at Wheeling Hospital. Join to apply for the Insurance Specialist - General Surgery Department role at Wheeling Hospital. This position is 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.

The role aims to minimize reimbursement errors resulting from inaccuracy of referral and enrollment information.

• Identify all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follow up on accounts as indicated by system flags.
• Contact insurance company or employer to determine eligibility and benefits for requested services.
• Follow up with the patient, insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
• Use work queues within the EPIC system for scheduling, transition of care, and billing edits.
• Perform medical necessity screening as required by third party payors.
• Document referrals/authorization/certification numbers in the EPIC system.
• Initiate charge anticipation calculations and accurately identify anticipated charges to assure identification of anticipated self-pay portions.
• Communicate with the patient the anticipated self-pay portion, co-payments/deductibles/co-insurance, and account balance; refer self-pay patients to in-house Financial Counselors to determine eligibility as needed.
• Assist Patient Financial Services with denial management issues and appeal denials based on medical necessity as needed.
• Communicate problems hindering workflow to management in a timely manner.
• Assess all self-pay patients for potential public assistance through registration/billing systems and provide financial counseling information; maintain knowledge of major payor payment provisions.

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

• Previous insurance authorization experience.

• Excellent oral and written communication skills.
• Basic knowledge of medical terminology.
• Basic knowledge of ICD-10 and CPT coding, third party payors, and business math.
• General knowledge of time of service collection procedures.
• Excellent customer service and telephone etiquette.
• Minimum typing speed of 25 words per minute.
• Reading and comprehension ability.

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

• Standard office environment.

• Wheeling Hospital Inc. – 1 Medical Park Drive, Wheeling, West Virginia.
• West Virginia University Health System and its subsidiaries are an equal opportunity employer and comply with all applicable federal, state, and local fair employment practices laws. WVUHS prohibits discrimination in all terms and conditions of employment.

• Scheduled Weekly
  
  Hours:
  
  40
• Exempt/Non-Exempt:
  Non-Exempt
• Shift: United States of America (Non-Exempt)

• Address: 1 Medical Park Drive, Wheeling, West Virginia
• Industry: Hospitals and Health Care