Insurance Specialist at WVU Medicine: Join Our Team in Morgantown!

Role Overview

Are you a detail-oriented and compassionate professional with a background in insurance and healthcare? WVU Medicine is seeking a dedicated Insurance Specialist to join our team at the Cornerstone Specialty Care Center in Morgantown, West Virginia. In this critical role, you will be responsible for ensuring that all appointments and procedures are properly authorized, verifying insurance coverage, and communicating financial responsibilities to our patients. Your expertise will help minimize reimbursement errors and contribute to a seamless patient experience.

A Day in the Life of an Insurance Specialist

As an Insurance Specialist, your day will be dynamic and focused on providing essential support to both patients and healthcare providers. Here’s a glimpse into your daily routine:

1. Pre-Certification and Pre-Authorization: You'll start by identifying patients who require pre-certification or pre-authorization for their scheduled services. This involves reviewing patient records, understanding the services they need, and preparing the necessary documentation.
2. Insurance Verification: You will contact insurance carriers to verify patient coverage and understand benefit limitations. This includes navigating complex insurance policies and understanding the nuances of different plans.
3. Communication with Stakeholders: You will communicate with insurance companies, employers, patients, and other hospital departments to resolve any insurance coverage issues. This requires excellent communication skills and the ability to explain complex information clearly and concisely.
4. EPIC System Management: You will use work queues within the EPIC system to manage scheduling, transition of care, and billing edits. This involves maintaining accurate records and ensuring that all information is up-to-date.
5. Medical Necessity Screening: You will perform medical necessity screenings as required by third-party payors. This involves reviewing medical records and comparing them against established criteria to ensure that the services are medically necessary.
6. Documentation: You will document all referrals, authorizations, and certification numbers in the EPIC system. This is crucial for maintaining accurate records and ensuring compliance with regulatory requirements.
7. Charge Anticipation: You will initiate charge anticipation calculations to accurately identify anticipated charges and self-pay portions. This helps patients understand their financial responsibilities upfront.
8. Financial Counseling: You will communicate with patients about their anticipated self-pay portions, including co-payments, deductibles, and co-insurance. You will also refer self-pay patients with limited or exhausted benefits to in-house Financial Counselors to explore eligibility for financial assistance.
9. Denial Management: You will assist Patient Financial Services with denial management issues and appeal denials based on medical necessity as needed. This involves researching the reasons for denials and preparing appeals to overturn them.
10. Problem Solving: You will identify and communicate any problems hindering workflow to management in a timely manner. This ensures that issues are addressed promptly and that processes are continuously improved.
11. Public Assistance Assessment: You will assess all self-pay patients for potential public assistance through registration/billing systems. This helps patients access the resources they need to afford their healthcare.

Why Morgantown, West Virginia?

Morgantown is a vibrant city in northern West Virginia, known for its friendly atmosphere, affordable cost of living, and access to outdoor recreation. Home to West Virginia University, Morgantown offers a diverse cultural scene, excellent schools, and a thriving job market. Whether you enjoy hiking, biking, kayaking, or exploring local shops and restaurants, Morgantown has something for everyone.

Career Path

At WVU Medicine, we are committed to supporting your professional growth and development. The Insurance Specialist position can serve as a stepping stone to various career paths within our organization. Here are a few potential career advancement opportunities:

• Senior Insurance Specialist: With experience and proven performance, you can advance to a Senior Insurance Specialist role, where you will take on additional responsibilities such as mentoring junior team members and leading process improvement initiatives.
• Insurance Supervisor: You can move into a supervisory role, overseeing a team of Insurance Specialists and ensuring that all tasks are completed accurately and efficiently.
• Patient Access Manager: You can transition into a management role within the Patient Access department, where you will be responsible for managing the overall patient experience from initial contact through discharge.
• Revenue Cycle Analyst: You can leverage your knowledge of insurance and billing processes to become a Revenue Cycle Analyst, where you will analyze data to identify trends and opportunities for improvement.
• Financial Counselor: You can specialize in financial counseling, providing direct support to patients in understanding their financial obligations and accessing resources to help them afford their healthcare.

Salary and Benefits

WVU Medicine offers a competitive salary and benefits package to attract and retain top talent. The estimated salary range for the Insurance Specialist position in Morgantown, West Virginia, is $38,000 to $55,000 per year, depending on experience and qualifications. In addition to a competitive salary, you will also receive a comprehensive benefits package, including:

• Comprehensive health insurance (medical, dental, vision)
• Paid time off (PTO) for vacation, sick leave, and holidays
• Retirement plan with employer matching contributions
• Life insurance
• Disability insurance (short-term and long-term)
• Flexible spending accounts (FSAs) or health savings accounts (HSAs)
• Employee assistance program (EAP)
• Wellness programs
• Tuition reimbursement or assistance for continuing education
• Professional development opportunities
• Employee discounts on WVU Medicine services and products
• Employee recognition programs

WVU Medicine Culture

At WVU Medicine, we are committed to providing exceptional care to our patients and creating a supportive and inclusive work environment for our employees. We value teamwork, collaboration, and continuous improvement. As an Insurance Specialist, you will be part of a team of dedicated professionals who are passionate about making a difference in the lives of others.

How to Apply

If you are ready to join our team and contribute to our mission of providing high-quality healthcare to the communities we serve, we encourage you to apply online through our careers website. To apply to this position and be considered, click the Apply button located above this message and complete the application in full.

Frequently Asked Questions (FAQ)

1. What are the minimum qualifications for the Insurance Specialist position?

The minimum qualifications include a high school diploma or equivalent, a state criminal background check, and a federal background check (if applicable).

2. Is previous insurance authorization experience required?

Previous insurance authorization experience is preferred but not required.

3. What skills are essential for success in this role?

Essential skills include knowledge of insurance eligibility and benefits, understanding of medical necessity screening, proficiency in using electronic health record (EHR) systems, strong communication and interpersonal skills, and excellent problem-solving skills.

4. What are the typical working hours for this position?

The typical working hours are Monday through Friday, 8:00 AM to 5:00 PM, but may vary depending on the needs of the department.

5. What opportunities are there for professional development?

WVU Medicine offers various professional development opportunities, including tuition reimbursement, professional development programs, and opportunities to attend conferences and workshops.

6. What is the work environment like at WVU Medicine?

The work environment at WVU Medicine is supportive and collaborative, with a focus on teamwork and continuous improvement.

7. Are there opportunities for advancement within the organization?

Yes, WVU Medicine offers opportunities for advancement in various roles, including Senior Insurance Specialist, Insurance Supervisor, Patient Access Manager, and Revenue Cycle Analyst.

8. What is the dress code for this position?

The dress code is business casual.

9. What is the interview process like?

The interview process typically includes an initial phone screening followed by an in-person interview with the hiring manager and other members of the team.

10. How does WVU Medicine support employee well-being?

WVU Medicine supports employee well-being through various programs, including an employee assistance program (EAP), wellness programs, and employee recognition programs.