Medicare Claims Processor

Job not on LinkedIn

🔥 9 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 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

• Review and oversee adjudication of Medicare insurance claims ranging from simple data entry to complex specialty claim research • Analyze and process insurance claims, checking validity in accordance with all CMS guidelines • Screen, review, evaluate online entry, correct errors, and perform quality control for final adjudication of paper/electronic claims • Ensure accuracy of data entered and maintain records • Analyze claims to determine the extent of insurance carrier liability • Resolve claim edits, review history records, and determine benefit eligibility for services • Review payment levels and arrive at final payment determinations • Interpret contract benefits and adjudicate claims according to Medicare claims processing guidelines • Meet production and quality standards and maintain work queues according to department standards • Communicate effectively with internal and external colleagues • Elevate issues to the next level of supervision as appropriate • Attend required training classes and demonstrate proficiency and ability to learn • Read and interpret explanations of benefits (EOBs) • Provide mentorship to less experienced staff as assigned by leadership • Maintain patient/member confidentiality according to PHI and HIPAA guidelines

🎯 Requirements

• Associate Degree in related healthcare field OR high school diploma or equivalent AND three (3) years of healthcare claims billing and processing experience • One (1) year of Medicare claims processing experience • One (1) year of experience working with CMS/professional and UB/institutional claims • One (1) year of customer service experience • Ability to determine whether to return, deny, or pay claims while following organizational policies and procedures • Working knowledge of administrative and clerical procedures and systems, including word processing and managing files and records • Ability to take direction and navigate multiple systems simultaneously • Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette • Ability to solve problems with predefined methods and guidelines • Ability to use mathematics to adjudicate claims • Ability to understand medical insurance requirements for payment and basic knowledge of covered services • Working knowledge of Medicare medical insurance terminology, procedure and diagnosis codes, and HIPPA requirements • Ability to sit for extended periods of time • Comfortable working at times with limited social interaction • Bachelor’s degree in medical coding or related healthcare field OR four (4) years of equivalent industry work experience preferred • Three (3) years of Medicare claims processing experience preferred • Three (3) plus years of medical or institutional claims processing and customer service experience preferred • Experience in Medicare medical insurance and Medicare supplement preferred • Familiarity navigating EPIC software programs preferred

🏖️ Benefits

• Full-time schedule: 40 scheduled weekly hours • Non-exempt employment status