Insurance Authorization Specialist II

WVU Medicine

. Obtain authorizations for elective procedures, services, and tests to financially clear patients before services are rendered .

Posted 9/29/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in obtaining authorizations for medical procedures and services, ensuring compliance with insurance guidelines and coding standards. Proficient in managing financial clearance processes while maintaining effective communication with healthcare professionals and patients.

Highest-signal resume keywords

ICD-10 CodingCPT CodingAuthorization ProcessesEPIC System ProficiencyMedical Terminology

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD-10 CodingCPT CodingAuthorization ProcessesMedical TerminologyTime-of-Service Collection ProceduresBusiness MathTyping Speed of 25 Words Per MinuteAttention to DetailMultitaskingFinancial Clearance Compliance

Soft Skills

Excellent Communication SkillsInterpersonal SkillsAbility to Prioritize Deadlines

Tools & Technologies

EPIC SystemMicrosoft Office ApplicationsFax MachinesTelephones

Industry Keywords

Third-Party PayorsInsurance GuidelinesFinancial Clearance ProgramDenial ManagementClinical Documentation

About the role

Key responsibilities & impact

Obtain authorizations for elective procedures, services, and tests to financially clear patients before services are rendered
Use payor resources, medical policies, and reference materials to verify prior authorization requirements
Code cases and review clinical documentation for completeness
Escalate financial clearance risks in compliance with the Financial Clearance Program
Identify patients requiring pre-certification or pre-authorization
Contact insurance companies or employers to determine eligibility and benefits
Use EPIC work queues to obtain authorizations for referrals, tests, and surgeries within expected timeframes
Follow up on authorization requests, peer-to-peer reviews, denials, and prior authorization appeals
Ensure diagnosis, procedure, and facility coding align with obtained authorization
Verify services promptly to avoid treatment delays and reduce administrative time
Assist Patient Financial Services with denial management and obtain retro-authorizations as needed
Notify scheduling staff and physicians of cases not authorized within department policy
Maintain compliance with quality standards and productivity measures
Collaborate with physicians, financial clearance counselors, schedulers, nurses, patients, families, and other contacts
Maintain EPIC in-baskets and Outlook emails
Participate in monthly team meetings and one-on-ones
Follow established workflows and communicate process or system deficiencies to supervisors or managers
Maintain confidentiality of demographic, clinical, and financial information

Requirements

What you’ll need

High school graduate or equivalent with 2 years working experience in a medical environment, or an Associate’s degree and 1 year of experience in a medical environment required
3 years’ experience with medical terminology, ICD-10, and CPT codes
Understanding of authorization processes, insurance guidelines, and third-party payors
Proficiency in Microsoft Office applications
Excellent communication and interpersonal skills
Ability to prioritize deadlines and multitask a large work volume efficiently with attention to detail
Basic computer skills
Practical knowledge of medical terminology, ICD-10 and CPT coding, third-party payors, time-of-service collection procedures, and business math
Minimum typing speed of 25 words per minute
Excellent reading and comprehension ability
Ability to work prolonged periods sitting and extended periods on the telephone
Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment