Insurance Claims Specialist

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⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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 through accurate claim submission, regulatory compliance, timely follow-up, and denial management • 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 • 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 • Gather statistics, complete reports, and perform clerical duties • 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 hospital 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 • Attend department meetings, teleconferences, and webcasts as necessary • 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 in a timely manner

🎯 Requirements

• High School diploma or equivalent • 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 • Ability to sit for extended periods of time • Reading and comprehension ability • Visual acuity within normal range • Effective communication ability • Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment • 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 comply with HIPAA regulations and Notices of Privacy Practices • Must maintain confidentiality of demographic, clinical, and financial information

🏖️ Benefits

• Full-time schedule of 40 hours per week • Participation in educational programs for mandatory requirements, job growth, and personal growth • Reasonable accommodations may be made for individuals with disabilities