Insurance Claims Specialist

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

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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

• 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 scheduled or requested duties • Organize and prioritize daily tasks for productivity, accountability, and efficiency • Comply with Notices of Privacy Practices and HIPAA regulations for PHI and claim submission/follow-up • Contact third-party 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 • Participate in educational programs, 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 accurately and timely • Maintain knowledge of federal, state, and local professional billing regulations • Monitor accounts to facilitate timely follow-up and maximize cash receipts • Maintain work queue volumes and productivity within established guidelines • Provide customer service to patients, visitors, and employees • Participate in performance improvement initiatives • Work with supervisors and managers to develop and exceed annual goals • Maintain confidentiality of demographic, clinical, and financial information • Communicate workflow problems to management promptly

🎯 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 • 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 • Ability to understand written and oral communication • Ability to sit for extended periods • Reading and comprehension ability • Visual acuity within normal range • Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment • Must be able to communicate effectively

🏖️ Benefits

• Full-time schedule of 40 hours per week • Participation in educational programs for mandatory requirements and job/personal growth • Performance improvement initiatives • Reasonable accommodations for individuals with disabilities

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