Insurance Specialist III Careers at WVU Medicine - Remote | Apply Now!
WVU Medicine
Insurance Specialist III Careers at WVU Medicine - Remote | Apply Now!
Job Description
Insurance Specialist III at WVU Medicine: A Rewarding Career
Role Overview
As an Insurance Specialist III at WVU Medicine, you play a crucial role in ensuring patients receive the necessary authorizations for elective infusions and injections. This position is vital for financially clearing patients and securing reimbursement for the organization. Your expertise in navigating payor resources, understanding medical policies, and effectively communicating with clinical teams and pharmacists is essential for success. You will be responsible for coding cases, reviewing clinical documentation, and escalating financial clearance risks in compliance with the Financial Clearance Program.
A Day in the Life of an Insurance Specialist III
Your day-to-day tasks will involve:
- Managing workloads and prioritizing tasks using work queues within the EPIC system.
- Collecting and communicating outpatient benefit information to the Patient Financial Services team.
- Referring to medical and coverage policies for medications.
- Researching CPT codes for drugs/injections.
- Verifying authorization requirements through insurance portals or by contacting insurance companies.
- Submitting authorizations as a buy-and-bill via medical benefit for outpatient on-campus hospital requests.
- Reviewing and interpreting medical record documentation to answer clinical questions during the authorization process.
- Communicating with clinics to obtain additional information needed for authorizations.
- Following up on submitted authorization requests daily.
- Scheduling and following up on peer-to-peer reviews.
- Submitting and following up with prior authorization appeals for denied medications.
- Communicating when home infusion or pharmacy benefit is needed.
- Verifying referrals and authorizations in work queues.
- Identifying changes in medication dosing/frequency.
- Assisting Patient Financial Services with denial management issues and obtaining retro authorizations.
- Maintaining in-baskets in Epic and emails in Outlook.
Why Remote?
This remote position offers several advantages:
- Flexibility: Work from the comfort of your home, allowing for a better work-life balance.
- Convenience: Eliminate commuting time and costs.
- Productivity: Create a personalized workspace that enhances your focus and efficiency.
- Accessibility: Access WVU Medicine’s resources and systems remotely.
- Collaboration: Stay connected with your team through virtual meetings and communication tools.
Career Path
WVU Medicine offers opportunities for career advancement. Starting as an Insurance Specialist III, you can progress to roles such as:
- Senior Insurance Specialist: Lead complex authorization cases and mentor junior team members.
- Authorization Supervisor: Oversee a team of insurance specialists and manage daily operations.
- Financial Clearance Manager: Develop and implement financial clearance strategies and policies.
- Revenue Cycle Analyst: Analyze revenue cycle data to identify trends and improve processes.
Salary and Benefits
The estimated salary range for an Insurance Specialist III at WVU Medicine is $40,000 to $65,000 per year. In addition to a competitive salary, WVU Medicine offers a comprehensive benefits package, including:
- Comprehensive health insurance coverage.
- Generous paid time off (PTO).
- Retirement savings plan with employer matching.
- Life insurance and disability coverage.
- Flexible spending accounts (FSAs).
- Employee assistance program (EAP).
- Wellness programs and resources.
- Tuition reimbursement or assistance.
- Employee discounts.
WVU Medicine Culture
WVU Medicine is committed to:
- Patient-centered care: Putting patients first and providing compassionate care.
- Teamwork: Collaborating to achieve shared goals.
- Innovation: Embracing new ideas and technologies to improve healthcare.
- Integrity: Maintaining the highest ethical standards.
- Respect: Valuing diversity and treating everyone with dignity.
WVU Medicine fosters a supportive and inclusive work environment where employees are empowered to grow and make a difference.
How to Apply
To apply for the Insurance Specialist III position, click the Apply button located at the top of this page and complete the application in full.
Frequently Asked Questions (FAQ)
- What are the minimum qualifications for this position?
High school graduate or equivalent with 2 years of experience in a medical environment OR Associate’s degree and 1 year of experience in a medical environment.
- What experience is preferred?
3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes. Understanding of authorization processes, insurance guidelines, and third-party payor practices. Proficiency in Microsoft Office applications. Excellent communication and interpersonal skills.
- What is the primary responsibility of this role?
Obtaining authorizations for elective infusions and injections to financially clear patients and ensure reimbursement for the organization.
- What systems will I be using in this role?
EPIC system, insurance portals, and Microsoft Office applications.
- How does this role contribute to patient care?
By ensuring timely and accurate authorization for necessary medical treatments, which helps patients receive the care they need without financial delays.
- What opportunities are there for professional development?
WVU Medicine offers tuition reimbursement, professional development opportunities, and career advancement programs.
- What is the work environment like?
WVU Medicine fosters a supportive and collaborative work environment with a focus on teamwork and patient-centered care.
- Is this a remote position?
Yes, this is a remote position.
- What kind of training is provided?
WVU Medicine provides comprehensive training on its systems, authorization processes, and insurance guidelines.
- What growth opportunities are available at WVU Medicine?
WVU Medicine is always growing, and growth results in opportunities for employees to move to higher-level roles within the organization. Leadership development training is also available, which can further enhance upward mobility.
Locations
- Morgantown, West Virginia, United States (Remote)
Salary
44,000 - 71,500 USD / yearly
Source: ai estimated
* This is an estimated range based on market data and may vary based on experience and qualifications.
Skills Required
- Prior Authorizationintermediate
- Insurance Verificationintermediate
- Medical Terminologyintermediate
- ICD-10 Codingintermediate
- CPT Codingintermediate
- Insurance Guidelinesintermediate
- Third-Party Payorsintermediate
- Microsoft Officeintermediate
- Communication Skillsintermediate
- Interpersonal Skillsintermediate
- Prioritizationintermediate
- Time Managementintermediate
- Multitaskingintermediate
- Attention to Detailintermediate
- Computer Skillsintermediate
- EPIC Systemintermediate
- Medical Record Reviewintermediate
- Denial Managementintermediate
- Appeals Processingintermediate
- Problem Solvingintermediate
Required Qualifications
- High school graduate or equivalent with 2 years of experience in a medical environment (hospital, doctor’s office, or ambulatory clinic) OR Associate’s degree and 1 year of experience in a medical environment. (experience)
- Knowledge and interpretation of medical terminology, ICD-10, and CPT codes. (experience)
- Understanding of authorization processes, insurance guidelines, and third-party payor practices. (experience)
- Proficiency in Microsoft Office applications. (experience)
- Excellent communication and interpersonal skills. (experience)
- Ability to prioritize to meet deadlines and multitask a large work volume with a high level of efficiency and attention to detail. (experience)
- Basic computer skills. (experience)
- Experience with EPIC system or similar electronic health record (EHR) systems. (experience)
- Familiarity with medical and coverage policies for medications. (experience)
- Ability to research CPT codes for drugs/injections. (experience)
- Experience using insurance portals and contacting insurance companies for verification. (experience)
- Strong analytical and problem-solving skills. (experience)
- Ability to work independently and as part of a team. (experience)
- Commitment to patient financial clearance and reimbursement accuracy. (experience)
- Understanding of HIPAA regulations and patient privacy. (experience)
Responsibilities
- Manage workloads and prioritize tasks using work queues within the EPIC system 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 to determine appropriate coverage.
- Research CPT codes for drugs/injections to ensure accurate billing and authorization.
- Verify authorization requirements by utilizing insurance portals or calling insurance companies.
- 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 insurance companies.
- Review and interpret medical record documentation to answer clinical questions during the authorization process.
- Communicate clearly and effectively with clinics when additional information is needed for authorizations.
- Use hospital communication systems (fax, pagers, telephones, copiers, scanners, and computers) in accordance with hospital standards.
- Follow up daily on submitted authorization requests to ensure timely processing.
- Schedule and follow up on peer-to-peer reviews with physicians as required.
- Submit and follow up with prior authorization appeals for denied medications.
- Communicate clearly and effectively to the appropriate persons when home infusion or pharmacy benefit is needed.
- Verify referrals and authorizations in work queues to ensure accuracy.
- Identify changes in medication dosing/frequency to update authorization requests.
- Assist Patient Financial Services with denial management issues and obtain retro authorizations as needed.
- Maintain in-baskets in Epic and emails in Outlook for effective communication and task management.
- Stay updated on changes in insurance guidelines and regulations related to prior authorizations.
- Participate in training and development activities to enhance knowledge and skills.
- Adhere to all WVU Medicine policies and procedures.
- Collaborate with pharmacists and other healthcare professionals to resolve authorization issues.
- Maintain confidentiality of patient information in accordance with HIPAA regulations.
- Contribute to a positive and supportive work environment.
Benefits
- general: Comprehensive health insurance coverage, including medical, dental, and vision plans.
- general: Generous paid time off (PTO) policy for vacation, sick leave, and holidays.
- general: Retirement savings plan with employer matching contributions to help you save for the future.
- general: Life insurance and disability coverage to protect you and your family.
- general: Flexible spending accounts (FSAs) for healthcare and dependent care expenses.
- general: Employee assistance program (EAP) for confidential counseling and support services.
- general: Wellness programs and resources to promote your physical and mental well-being.
- general: Tuition reimbursement or assistance for continuing education and professional development.
- general: Opportunities for career advancement and growth within WVU Medicine.
- general: Employee discounts on various products and services.
- general: On-site childcare facilities (availability may vary by location).
- general: Free parking or transportation assistance.
- general: A supportive and collaborative work environment.
- general: Opportunities to participate in community outreach and volunteer activities.
- general: Recognition programs to acknowledge and reward employee contributions.
- general: Access to state-of-the-art technology and equipment.
- general: A commitment to diversity and inclusion in the workplace.
- general: Opportunities to work with a team of dedicated and passionate healthcare professionals.
- general: Employee referral program with potential bonuses for successful referrals.
- general: Competitive salary and compensation package.
- general: Relocation assistance (if applicable).
- general: Sign-on bonus (if applicable).
- general: Professional development opportunities, including conferences and workshops.
- general: Opportunities to participate in research and innovation initiatives.
- general: Employee resource groups (ERGs) to connect with colleagues who share similar interests and backgrounds.
- general: Opportunities to contribute to process improvement and quality initiatives.
- general: Access to online learning platforms for skill development.
Tags & Categories
Answer 10 quick questions to check your fit for Insurance Specialist III Careers at WVU Medicine - Remote | Apply Now! @ WVU Medicine.
Related Books and Jobs
Insurance Specialist III Careers at WVU Medicine - Remote | Apply Now!
WVU Medicine
Insurance Specialist III Careers at WVU Medicine - Remote | Apply Now!
Job Description
Insurance Specialist III at WVU Medicine: A Rewarding Career
Role Overview
As an Insurance Specialist III at WVU Medicine, you play a crucial role in ensuring patients receive the necessary authorizations for elective infusions and injections. This position is vital for financially clearing patients and securing reimbursement for the organization. Your expertise in navigating payor resources, understanding medical policies, and effectively communicating with clinical teams and pharmacists is essential for success. You will be responsible for coding cases, reviewing clinical documentation, and escalating financial clearance risks in compliance with the Financial Clearance Program.
A Day in the Life of an Insurance Specialist III
Your day-to-day tasks will involve:
- Managing workloads and prioritizing tasks using work queues within the EPIC system.
- Collecting and communicating outpatient benefit information to the Patient Financial Services team.
- Referring to medical and coverage policies for medications.
- Researching CPT codes for drugs/injections.
- Verifying authorization requirements through insurance portals or by contacting insurance companies.
- Submitting authorizations as a buy-and-bill via medical benefit for outpatient on-campus hospital requests.
- Reviewing and interpreting medical record documentation to answer clinical questions during the authorization process.
- Communicating with clinics to obtain additional information needed for authorizations.
- Following up on submitted authorization requests daily.
- Scheduling and following up on peer-to-peer reviews.
- Submitting and following up with prior authorization appeals for denied medications.
- Communicating when home infusion or pharmacy benefit is needed.
- Verifying referrals and authorizations in work queues.
- Identifying changes in medication dosing/frequency.
- Assisting Patient Financial Services with denial management issues and obtaining retro authorizations.
- Maintaining in-baskets in Epic and emails in Outlook.
Why Remote?
This remote position offers several advantages:
- Flexibility: Work from the comfort of your home, allowing for a better work-life balance.
- Convenience: Eliminate commuting time and costs.
- Productivity: Create a personalized workspace that enhances your focus and efficiency.
- Accessibility: Access WVU Medicine’s resources and systems remotely.
- Collaboration: Stay connected with your team through virtual meetings and communication tools.
Career Path
WVU Medicine offers opportunities for career advancement. Starting as an Insurance Specialist III, you can progress to roles such as:
- Senior Insurance Specialist: Lead complex authorization cases and mentor junior team members.
- Authorization Supervisor: Oversee a team of insurance specialists and manage daily operations.
- Financial Clearance Manager: Develop and implement financial clearance strategies and policies.
- Revenue Cycle Analyst: Analyze revenue cycle data to identify trends and improve processes.
Salary and Benefits
The estimated salary range for an Insurance Specialist III at WVU Medicine is $40,000 to $65,000 per year. In addition to a competitive salary, WVU Medicine offers a comprehensive benefits package, including:
- Comprehensive health insurance coverage.
- Generous paid time off (PTO).
- Retirement savings plan with employer matching.
- Life insurance and disability coverage.
- Flexible spending accounts (FSAs).
- Employee assistance program (EAP).
- Wellness programs and resources.
- Tuition reimbursement or assistance.
- Employee discounts.
WVU Medicine Culture
WVU Medicine is committed to:
- Patient-centered care: Putting patients first and providing compassionate care.
- Teamwork: Collaborating to achieve shared goals.
- Innovation: Embracing new ideas and technologies to improve healthcare.
- Integrity: Maintaining the highest ethical standards.
- Respect: Valuing diversity and treating everyone with dignity.
WVU Medicine fosters a supportive and inclusive work environment where employees are empowered to grow and make a difference.
How to Apply
To apply for the Insurance Specialist III position, click the Apply button located at the top of this page and complete the application in full.
Frequently Asked Questions (FAQ)
- What are the minimum qualifications for this position?
High school graduate or equivalent with 2 years of experience in a medical environment OR Associate’s degree and 1 year of experience in a medical environment.
- What experience is preferred?
3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes. Understanding of authorization processes, insurance guidelines, and third-party payor practices. Proficiency in Microsoft Office applications. Excellent communication and interpersonal skills.
- What is the primary responsibility of this role?
Obtaining authorizations for elective infusions and injections to financially clear patients and ensure reimbursement for the organization.
- What systems will I be using in this role?
EPIC system, insurance portals, and Microsoft Office applications.
- How does this role contribute to patient care?
By ensuring timely and accurate authorization for necessary medical treatments, which helps patients receive the care they need without financial delays.
- What opportunities are there for professional development?
WVU Medicine offers tuition reimbursement, professional development opportunities, and career advancement programs.
- What is the work environment like?
WVU Medicine fosters a supportive and collaborative work environment with a focus on teamwork and patient-centered care.
- Is this a remote position?
Yes, this is a remote position.
- What kind of training is provided?
WVU Medicine provides comprehensive training on its systems, authorization processes, and insurance guidelines.
- What growth opportunities are available at WVU Medicine?
WVU Medicine is always growing, and growth results in opportunities for employees to move to higher-level roles within the organization. Leadership development training is also available, which can further enhance upward mobility.
Locations
- Morgantown, West Virginia, United States (Remote)
Salary
44,000 - 71,500 USD / yearly
Source: ai estimated
* This is an estimated range based on market data and may vary based on experience and qualifications.
Skills Required
- Prior Authorizationintermediate
- Insurance Verificationintermediate
- Medical Terminologyintermediate
- ICD-10 Codingintermediate
- CPT Codingintermediate
- Insurance Guidelinesintermediate
- Third-Party Payorsintermediate
- Microsoft Officeintermediate
- Communication Skillsintermediate
- Interpersonal Skillsintermediate
- Prioritizationintermediate
- Time Managementintermediate
- Multitaskingintermediate
- Attention to Detailintermediate
- Computer Skillsintermediate
- EPIC Systemintermediate
- Medical Record Reviewintermediate
- Denial Managementintermediate
- Appeals Processingintermediate
- Problem Solvingintermediate
Required Qualifications
- High school graduate or equivalent with 2 years of experience in a medical environment (hospital, doctor’s office, or ambulatory clinic) OR Associate’s degree and 1 year of experience in a medical environment. (experience)
- Knowledge and interpretation of medical terminology, ICD-10, and CPT codes. (experience)
- Understanding of authorization processes, insurance guidelines, and third-party payor practices. (experience)
- Proficiency in Microsoft Office applications. (experience)
- Excellent communication and interpersonal skills. (experience)
- Ability to prioritize to meet deadlines and multitask a large work volume with a high level of efficiency and attention to detail. (experience)
- Basic computer skills. (experience)
- Experience with EPIC system or similar electronic health record (EHR) systems. (experience)
- Familiarity with medical and coverage policies for medications. (experience)
- Ability to research CPT codes for drugs/injections. (experience)
- Experience using insurance portals and contacting insurance companies for verification. (experience)
- Strong analytical and problem-solving skills. (experience)
- Ability to work independently and as part of a team. (experience)
- Commitment to patient financial clearance and reimbursement accuracy. (experience)
- Understanding of HIPAA regulations and patient privacy. (experience)
Responsibilities
- Manage workloads and prioritize tasks using work queues within the EPIC system 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 to determine appropriate coverage.
- Research CPT codes for drugs/injections to ensure accurate billing and authorization.
- Verify authorization requirements by utilizing insurance portals or calling insurance companies.
- 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 insurance companies.
- Review and interpret medical record documentation to answer clinical questions during the authorization process.
- Communicate clearly and effectively with clinics when additional information is needed for authorizations.
- Use hospital communication systems (fax, pagers, telephones, copiers, scanners, and computers) in accordance with hospital standards.
- Follow up daily on submitted authorization requests to ensure timely processing.
- Schedule and follow up on peer-to-peer reviews with physicians as required.
- Submit and follow up with prior authorization appeals for denied medications.
- Communicate clearly and effectively to the appropriate persons when home infusion or pharmacy benefit is needed.
- Verify referrals and authorizations in work queues to ensure accuracy.
- Identify changes in medication dosing/frequency to update authorization requests.
- Assist Patient Financial Services with denial management issues and obtain retro authorizations as needed.
- Maintain in-baskets in Epic and emails in Outlook for effective communication and task management.
- Stay updated on changes in insurance guidelines and regulations related to prior authorizations.
- Participate in training and development activities to enhance knowledge and skills.
- Adhere to all WVU Medicine policies and procedures.
- Collaborate with pharmacists and other healthcare professionals to resolve authorization issues.
- Maintain confidentiality of patient information in accordance with HIPAA regulations.
- Contribute to a positive and supportive work environment.
Benefits
- general: Comprehensive health insurance coverage, including medical, dental, and vision plans.
- general: Generous paid time off (PTO) policy for vacation, sick leave, and holidays.
- general: Retirement savings plan with employer matching contributions to help you save for the future.
- general: Life insurance and disability coverage to protect you and your family.
- general: Flexible spending accounts (FSAs) for healthcare and dependent care expenses.
- general: Employee assistance program (EAP) for confidential counseling and support services.
- general: Wellness programs and resources to promote your physical and mental well-being.
- general: Tuition reimbursement or assistance for continuing education and professional development.
- general: Opportunities for career advancement and growth within WVU Medicine.
- general: Employee discounts on various products and services.
- general: On-site childcare facilities (availability may vary by location).
- general: Free parking or transportation assistance.
- general: A supportive and collaborative work environment.
- general: Opportunities to participate in community outreach and volunteer activities.
- general: Recognition programs to acknowledge and reward employee contributions.
- general: Access to state-of-the-art technology and equipment.
- general: A commitment to diversity and inclusion in the workplace.
- general: Opportunities to work with a team of dedicated and passionate healthcare professionals.
- general: Employee referral program with potential bonuses for successful referrals.
- general: Competitive salary and compensation package.
- general: Relocation assistance (if applicable).
- general: Sign-on bonus (if applicable).
- general: Professional development opportunities, including conferences and workshops.
- general: Opportunities to participate in research and innovation initiatives.
- general: Employee resource groups (ERGs) to connect with colleagues who share similar interests and backgrounds.
- general: Opportunities to contribute to process improvement and quality initiatives.
- general: Access to online learning platforms for skill development.
Tags & Categories
Answer 10 quick questions to check your fit for Insurance Specialist III Careers at WVU Medicine - Remote | Apply Now! @ WVU Medicine.
Related Books and Jobs