Insurance Claims Specialist

🔥 2 minutes 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, regulatory compliance, timely follow-up, and denial management • Provide customer support and resolve issues arising from customer inquiries • Complete reports and clerical duties as needed • 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 and complete reports • Organize and prioritize daily tasks to optimize productivity, accountability, and efficiency • Follow HIPAA regulations and Notices of Privacy Practices regarding 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 • Attend educational programs, department meetings, teleconferences, and webcasts as necessary • Research and process mail returns and payer-rejected claims • Reconcile billing account transactions and process billing/follow-up transactions accurately and timely • Maintain knowledge of federal, state, and local hospital-billing regulations • Monitor accounts to facilitate timely follow-up and payment and maximize cash receipts • Maintain work queue volumes and productivity within established guidelines • Provide excellent customer service to patients, visitors, and employees • Participate in performance improvement initiatives • Work with supervisor and manager to develop and exceed annual goals • Maintain confidentiality regarding demographic, clinical, and financial information • Communicate workflow problems to management in a timely manner

🎯 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 • 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 • 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

🏖️ Benefits

• Participation in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions