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Job Responsibilities
This position is responsible for ensuring all appointments and procedures are authorized. Responsibilities include contacting insurance carriers to verify coverage and benefit limitations, obtaining pre-authorization for tests and procedures, scheduling them, calculating deductibles, co-payments, account balances, and fees, and noting relevant information in the system for front-end collection. The role also involves minimizing reimbursement errors caused by inaccuracies in referral and enrollment information.
Minimum Qualifications
- High school diploma or equivalent.
- State criminal background check and Federal check (if applicable), as required for regulated areas.
Preferred Qualifications
- Previous insurance authorization experience.
Core Duties and Responsibilities
The following statements describe the general nature of work performed by individuals in this position. They are not exhaustive, and other duties may be assigned.
- 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 companies or employers to determine eligibility and benefits for requested services.
- Follow up with patients, insurance companies, or providers to resolve insurance coverage issues and 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, and certification numbers in the EPIC system.
- Initiate charge anticipation calculations to identify anticipated charges and self-pay portions.
- Communicate with patients about anticipated co-payments, deductibles, co-insurance, and account balances. Refer self-pay or patients with limited/exhausted benefits to Financial Counselors for eligibility determination.
- Assist Patient Financial Services with denial management and appeal denials based on medical necessity as needed.
- Report workflow hindrances to management promptly.
- Assess all self-pay patients for potential public assistance and provide financial counseling information. Stay updated on major payor payment provisions.
Physical Requirements
Prolonged sitting, extended periods on the telephone requiring clarity of hearing and speaking, and manual dexterity to operate standard office equipment.
Work Environment
Standard office environment. Reasonable accommodations may be made for individuals with disabilities.
Skills and Abilities
- Excellent oral and written communication skills.
- Basic knowledge of medical terminology, ICD-10 and CPT coding, third-party payors, and business math.
- Understanding of time-of-service collection procedures.
- Excellent customer service and telephone etiquette.
- Minimum typing speed of 25 words per minute.
- Good reading and comprehension abilities.
Additional Job Details
- Scheduled Weekly Hours: 40
- Shift: Day (United States of America)
- Exempt/Non-Exempt: Non-Exempt
- Company: UHC United Hospital Center
- Cost Center: 69 UHC Rheumatology
- Address: 327 Medical Park Drive, Bridgeport, West Virginia
Equal Opportunity Employer
West Virginia University Health System and its subsidiaries are committed to equal employment opportunities and prohibit discrimination based on race, color, religion, sex, age, disability, and other protected characteristics. All employment decisions are made without regard to these factors, in accordance with applicable laws.
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