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The role serves as the initial point of contact for inquiries related to Insurance Authorization Specialist responsibilities. It involves overseeing daily operations to ensure timely acquisition of required prior authorizations. Collaborates closely with the Hospital Authorization Unit’s leadership team to implement and maintain efficient processes. Works in tandem with the denials management team to identify areas for improvement, aiming to reduce denials and increase revenue. Additionally, continues to actively perform the duties and responsibilities associated with being and Insurance authorization Specialist within the Hospital Authorization Unit.

MINIMUM QUALIFICATIONS:

1. High school graduate or equivalent with 3-4 years working experience in a medical environment, (such as a hospital, doctor’s office, or ambulatory clinic.)

2. OR an Associate’s degree and 2 years of experience in a medical environment required.

PREFERRED QUALIFICATIONS:

1. 3-4 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes.

2. Understanding of authorization processes, insurance guidelines, and third-party payors

practices.

3. Proficiency in Microsoft Office applications.

4. Excellent communication and people skills.

5. Ability to prioritize to meet deadlines and multitask a large work volume with an elevated level of efficiency and attention to detail.

6. Basic computer skills.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Reviews Hospital Authorization Unit’s denials, trend denials, work with Hospital Authorization Unit’s leadership team to identify and implement process improvements.

2. Attends Hospital Authorization Unit’s related meetings as an insurance authorization specialist representative, giving valuable input for process improvements.

3. Works closely with the Hospital Authorization Unit management team and all staff within the department.

4. Serves as first point of contact for questions from co-workers and members of the Hospital Authorization Unit’s team.

5. Collaborates closely with the Hospital Authorization Unit management team and trainer on creating and maintaining a current insurance specialist training guide.

6. Responsible for allocating daily workload among team members based on volume and priority levels.

7. Provides training, coaches, and mentors all Hospital Authorization Unit’s insurance authorization specialist staff.

8. Ensures that all patient visits and procedures are authorized prior to services are rendered. If services are denied by the payor, ensures that information is communicated to appropriate clinical and support staff.

9. Listen to team members’ feedback and resolve any issues or conflicts.

10. Informs leadership team of any issues or concerns that arise.

11. Acts as point of contact for clinical nursing teams to problem solve emergent cases.

12. Reviews work performed by Hospital Authorization Unit’s insurance specialists’ staff to ensure accuracy and compliance with established guidelines.

13. Creates an inspiring environment and fosters an open communication culture.

14. Sets clear goals for the team.

15. Delegates tasks to staff as appropriate and sets deadlines.

16. Monitors team performance a reports on metrics to department leadership.

17. Motivates and provides support for team members.

18. Recognizes team members who exceed expectations and high-performing staff for their accomplishments.

19. Encourages creativity and efficiency amongst the team.

20. Suggests and organizes team building activities for the group.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for extended periods of time

2. Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment

3. Must be able to wear headset for extended periods of time

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Shared office space

2. May encounter work interruption from clinical staff requiring immediate attention

SKILLS AND ABILITIES:

1. Must be able to handle multiple tasks and direct other’s activities efficiently

2. Ability to follow written and oral instruction

3. Basic computer skills proficiency

4. Familiar with medical terminology

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

536 SYSTEM Hospital Authorization Unit