Insurance Authorization Specialist III

WVU Medicine

. Obtain authorizations for elective infusions and injections to financially clear patients and ensure reimbursement .

Posted 9/17/2026full-timeRemote • Virginia • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in managing authorizations for elective infusions and injections, ensuring compliance with insurance guidelines and maximizing reimbursement through effective communication and documentation. Proficient in utilizing EPIC systems for workload management and patient financial services.

Highest-signal resume keywords

Authorization ProcessesICD-10 CodingCPT Code InterpretationMicrosoft Office ProficiencyExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical TerminologyPrior Authorization ManagementCoding and Documentation ReviewDenial ManagementTyping Speed of 25 Words Per Minute

Soft Skills

Interpersonal SkillsAttention to DetailMultitasking AbilityEfficiency in Work VolumeRespectful Communication

Tools & Technologies

EPIC SystemInsurance PortalsOutlook Email

Industry Keywords

Financial Clearance ProgramOutpatient Clinical EnvironmentThird-Party PayorsMedical PoliciesBenefit Information

About the role

Key responsibilities & impact

Obtain authorizations for elective infusions and injections to financially clear patients and ensure reimbursement
Use payor resources and medical policies to verify prior authorization requirements
Escalate financial clearance risks in compliance with the Financial Clearance Program
Liaise between clinical teams and pharmacists regarding infusion prior authorization issues
Code cases and review clinical documentation for completeness and maximum reimbursement
Manage workloads and prioritize deadlines using EPIC work queues
Collect and communicate outpatient benefit information to Patient Financial Services through Epic queues and billing indicators
Refer to medical and coverage policies for medications and research CPT codes for drugs/injections
Verify and submit authorizations through insurance portals, forms, or calls
Review medical records to answer clinical authorization questions
Communicate with clinics when additional information is needed
Follow up on authorization requests, peer-to-peer reviews, and prior authorization appeals
Communicate when home infusion or pharmacy benefits are needed
Verify referrals and authorizations in work queues and identify medication dosing/frequency changes
Assist with denial management and obtain retro authorizations
Maintain Epic in baskets and Outlook emails
Participate in monthly team meetings and one-on-ones
Build admissions and submit authorizations for elective inpatient chemotherapy admissions and observations
Follow workflows, report process deficiencies, maintain confidentiality, and communicate respectfully with staff, physicians, patients, families, and the public

Requirements

What you’ll need

High school graduate or equivalent with 2 years working experience in a medical environment, or 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 (preferred)
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 efficiency and attention to detail
Basic computer skills
Minimum typing speed of 25 words per minute
Reading and comprehension ability
Ability to work in an outpatient clinical environment
United States of America work environment

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account WVU Medicine Website LinkedIn All Job Openings 10,000+ employees 🏥 Healthcare ⚕️ Healthcare Insurance Healthcare
Healthcare Insurance WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves. Insurance Authorization Specialist III 🔥 2 minutes ago ⚔️ Virginia, West Virginia – Remote ⏰ Full Time 🟢 Junior 🔒 Insurance 🚫👨‍🎓 No degree required 👻 Ghost score 10% Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Obtain authorizations for elective infusions and injections to financially clear patients and ensure reimbursement
Use payor resources and medical policies to verify prior authorization requirements
Escalate financial clearance risks in compliance with the Financial Clearance Program
Liaise between clinical teams and pharmacists regarding infusion prior authorization issues
Code cases and review clinical documentation for completeness and maximum reimbursement
Manage workloads and prioritize deadlines using EPIC work queues
Collect and communicate outpatient benefit information to Patient Financial Services through Epic queues and billing indicators
Refer to medical and coverage policies for medications and research CPT codes for drugs/injections
Verify and submit authorizations through insurance portals, forms, or calls
Review medical records to answer clinical authorization questions
Communicate with clinics when additional information is needed
Follow up on authorization requests, peer-to-peer reviews, and prior authorization appeals
Communicate when home infusion or pharmacy benefits are needed
Verify referrals and authorizations in work queues and identify medication dosing/frequency changes
Assist with denial management and obtain retro authorizations
Maintain Epic in baskets and Outlook emails
Participate in monthly team meetings and one-on-ones
Build admissions and submit authorizations for elective inpatient chemotherapy admissions and observations
Follow workflows, report process deficiencies, maintain confidentiality, and communicate respectfully with staff, physicians, patients, families, and the public 🎯 Requirements
High school graduate or equivalent with 2 years working experience in a medical environment, or 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 (preferred)
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 efficiency and attention to detail
Basic computer skills
Minimum typing speed of 25 words per minute
Reading and comprehension ability
Ability to work in an outpatient clinical environment
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