Senior Insurance Claims Specialist

November 13

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WVU Medicine

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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.

10,000+ employees

⚕️ Healthcare Insurance

📋 Description

• Responsible for managing patient account balances including accurate claim submission • Compliance with all federal/state and third party billing regulations • Timely follow-up and assistance with denial management • Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues • Serves as a resource for co-worker process questions and concerns • Supports the work of the department by completing reports and clerical duties as needed • Works with leadership and other team members to achieve best in class revenue cycle operations • Submits accurate and timely claims to third party payers • Resolves claim edits and account errors prior to claim submission • Gathers statistics, completes reports and performs other duties as scheduled or requested • Organizes and executes daily tasks in appropriate priority • 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 • Researches and processes mail returns and claims rejected by the payer • Reconciles billing account transactions to ensure accurate account information

🎯 Requirements

• High School Graduate or equivalent • Certified Revenue Cycle Representative (CRCR) Certification from AAHAM or HFMA within 90 days of hire • Completes eight hours of revenue cycle continuing education required annually • Three (3) years medical billing/medical office experience • Three (3) years medical billing/medical office experience, preferably related to claims billing and insurance follow-up • Excellent oral and written communication skills • Working knowledge of computers • Knowledge of medical terminology preferred • Knowledge of third party payers required • 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 current knowledge of third party payer and managed care billing requirements and contracts

🏖️ Benefits

• 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