Insurance Specialist III

Job Description:• Utilize work queues within the EPIC system to manage workloads and prioritize 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. • Research CPT codes for drugs/injections. • Verify authorization requirements by utilizing insurance portals or calling insurances. • 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 insurances.• Review and interpret medical record documentation to answer clinical questions during the authorization process. • Clearly and effectively communicate with clinics when additional information is needed. • Uses hospital communications systems (fax, pagers, telephones, copiers, scanners, and computers) in accordance with hospital standards. • Daily follow up on submitted authorization requests. • Scheduling and following up on peer to peers. • Submitting and following up with prior authorization appeals for denied medications.• Clearly and effectively communicate to the appropriate persons when home infusion or pharmacy benefit is needed. • Verification of referrals and authorizations in work queues. • Identify changes in medication dosing/frequency. • Assists Patient Financial Services with denial management issues and will obtain retro authorizations as needed. • Maintain in baskets in Epic and emails in Outlook. • Participate in monthly team meetings and one-on-ones. • Builds admissions and submit authorization for elective inpatient chemotherapy admission and observations.• Follows established workflows, identifies deviations or deficiencies in standards/systems/processes and communicates problems to supervisor or manager. • Is polite and respectful when communicating with staff, physicians, patients, and families. Approaches interpersonal relations in a positive manner. • Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information. Requirements:• High school graduate or equivalent with 2 years working experience in a medical environment, (such as a hospital, doctor’s office, or ambulatory clinic.)• Associate’s degree and 1 year of experience in a medical environment.• 3 years’ experience of knowledge and interpretation of medical terminology, ICD-10, and CPT codes. • Understanding of authorization processes, insurance guidelines, and third-party payors practices. • Proficiency in Microsoft Office applications. • Excellent communication and interpersonal skills. • Ability to prioritize to meet deadlines and multitask a large work volume with a high level of efficiency and attention to detail. • Basic computer skills. Benefits:• Health insurance• 401(k) plan Apply tot his job