WVU Medicine
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Insurance Claims Specialist HB
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WVU Medicine Welcome! Were excited youre considering an opportunity with us. To apply to this position and be considered, click the Apply button above and complete the application in full. Below, youll find important information about this position. Core duties and responsibilities Submits accurate and timely claims to third party payers. Resolves claim edits and account errors prior to claim submission. Adheres to procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. Gathers statistics, completes reports and performs other duties as scheduled or requested. Organizes and executes daily tasks to achieve productivity, accountability and efficiency. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. Contacts third party payers to resolve unpaid claims. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. Assists Patient Access and Care Management with denials investigation and resolution. Participates in educational programs to meet mandatory requirements and identified needs. Attends department meetings, teleconferences and webcasts as necessary. Researches and processes mail returns and claims rejected by the payer. Reconciles billing account transactions to ensure accurate account information. Processes billing and follow-up transactions in an accurate and timely manner. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. Maintains work queue volumes and productivity within established guidelines. Provides excellent customer service to patients, visitors and employees. Participates in performance improvement initiatives as requested. Works with supervisor and manager to develop and exceed annual goals. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. Communicates problems hindering workflow to management in a timely manner.
Minimum qualifications
High School diploma or equivalent.
Experience
One (1) year medical billing/medical office experience preferred.
Skills and abilities
Excellent oral and written communication skills. Working knowledge of computers. Knowledge of medical terminology preferred. Knowledge of business math preferred. Knowledge of ICD-10 and CPT coding processes preferred. Excellent customer service and telephone etiquette. Ability to use tact and diplomacy in dealing with others. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. Ability to understand written and oral communication.
Physical requirements
Must be able to sit for extended periods of time. Must have reading and comprehension ability. Visual acuity must be within normal range. Must be able to communicate effectively. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment.
Working environment
Office type environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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Insurance Claims Specialist HB
role at
WVU Medicine Welcome! Were excited youre considering an opportunity with us. To apply to this position and be considered, click the Apply button above and complete the application in full. Below, youll find important information about this position. Core duties and responsibilities Submits accurate and timely claims to third party payers. Resolves claim edits and account errors prior to claim submission. Adheres to procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. Gathers statistics, completes reports and performs other duties as scheduled or requested. Organizes and executes daily tasks to achieve productivity, accountability and efficiency. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. Contacts third party payers to resolve unpaid claims. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. Assists Patient Access and Care Management with denials investigation and resolution. Participates in educational programs to meet mandatory requirements and identified needs. Attends department meetings, teleconferences and webcasts as necessary. Researches and processes mail returns and claims rejected by the payer. Reconciles billing account transactions to ensure accurate account information. Processes billing and follow-up transactions in an accurate and timely manner. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. Maintains work queue volumes and productivity within established guidelines. Provides excellent customer service to patients, visitors and employees. Participates in performance improvement initiatives as requested. Works with supervisor and manager to develop and exceed annual goals. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. Communicates problems hindering workflow to management in a timely manner.
Minimum qualifications
High School diploma or equivalent.
Experience
One (1) year medical billing/medical office experience preferred.
Skills and abilities
Excellent oral and written communication skills. Working knowledge of computers. Knowledge of medical terminology preferred. Knowledge of business math preferred. Knowledge of ICD-10 and CPT coding processes preferred. Excellent customer service and telephone etiquette. Ability to use tact and diplomacy in dealing with others. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. Ability to understand written and oral communication.
Physical requirements
Must be able to sit for extended periods of time. Must have reading and comprehension ability. Visual acuity must be within normal range. Must be able to communicate effectively. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment.
Working environment
Office type environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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