Insurance Claims Specialist – PB

🔥 18 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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WVU Medicine

WebsiteLinkedInAll 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.

📋 Description

• Manage patient account balances, including accurate claim submission and timely follow-up • Comply with federal, state, and third-party billing regulations • Assist with denial management to support hospital revenue cycle operations • Provide customer support and resolve issues arising from customer inquiries • Submit accurate and timely claims to third-party payers • Resolve claim edits and account errors before claim submission • Follow up with third-party payers to support collections and department goals • Gather statistics, complete reports, and perform clerical duties • Organize and prioritize daily tasks to optimize productivity and efficiency • Follow HIPAA regulations and Notices of Privacy Practices regarding PHI and claims • Contact payers to resolve unpaid claims • Use payer portals and websites to verify claim status and conduct account follow-up • Assist Patient Access and Care Management with denial investigation and resolution • Attend department meetings, teleconferences, and webcasts • Research and process returned mail and payer-rejected claims • Reconcile billing account transactions and process billing and follow-up transactions • Maintain knowledge of federal, state, and local professional billing regulations • Monitor accounts to facilitate timely payment and maximize cash receipts • Maintain work queue volumes and productivity within established guidelines • Provide customer service to patients, visitors, and employees • Work with supervisors and managers to develop and exceed annual goals • Maintain confidentiality of demographic, clinical, and financial information • Communicate workflow problems to management

🎯 Requirements

• High School diploma or equivalent • One (1) year medical billing/medical office experience preferred • Excellent oral and written communication skills • Working knowledge of computers • Excellent customer service and telephone etiquette • Ability to use tact and diplomacy in dealing with others • Ability to understand written and oral communication • Knowledge of medical terminology preferred • Knowledge of business math preferred • Knowledge of ICD-10 and CPT coding processes preferred • Knowledge of revenue cycle operations, third party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures • 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 • United States of America work location/status indicated

🏖️ Benefits

• Full-time schedule • 40 scheduled weekly hours • Participation in educational programs for mandatory requirements, job growth, and personal growth • Performance improvement initiatives • Reasonable accommodations for individuals with disabilities