WVU Medicine
Overview
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Responsibilities
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 determine 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.
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 self-pay patients for potential public assistance through registration/billing systems; provide financial counseling information and maintain knowledge of major payor provisions.
Qualifications Minimum Qualifications
High school diploma or equivalent.
State criminal background check and Federal (if applicable), as required for regulated areas.
Experience
Previous insurance authorization experience is preferred.
Additional Details
Scheduled Weekly Hours: 40
Shift: Day (United States of America)
Employment Type: Full-time (Non-Exempt)
Company: WVU Medicine / Summersville Regional Medical Center
Equal Opportunity Employer West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment.
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Responsibilities
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 determine 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.
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 self-pay patients for potential public assistance through registration/billing systems; provide financial counseling information and maintain knowledge of major payor provisions.
Qualifications Minimum Qualifications
High school diploma or equivalent.
State criminal background check and Federal (if applicable), as required for regulated areas.
Experience
Previous insurance authorization experience is preferred.
Additional Details
Scheduled Weekly Hours: 40
Shift: Day (United States of America)
Employment Type: Full-time (Non-Exempt)
Company: WVU Medicine / Summersville Regional Medical Center
Equal Opportunity Employer West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment.
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