Senior Insurance Claims Specialist

🔥 59 minutes ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟠 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 submission • Follow up with payers to support collections and department goals • Contact payers to resolve unpaid claims and use payer portals to verify claim status • Assist Patient Access and Care Management with denial investigation and resolution • Gather statistics, complete reports, and perform clerical duties • Reconcile billing account transactions and process billing and follow-up transactions • 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 • Maintain confidentiality and comply with HIPAA and privacy policies • Serve as a resource for coworker process questions and concerns • Work with the Hospital Billing Trainer to identify staff training opportunities • Serve as a Super User for Quadax, FISS, and other patient financial services software • Participate in performance improvement initiatives, departmental meetings, and policy reviews

🎯 Requirements

• High school graduate or equivalent • CRCR certification through HFMA or Certified Revenue Cycle Specialist certification through AAHAM within 90 days of hire • Three years of medical billing or medical office experience • Eight hours of revenue cycle continuing education annually • Knowledge of third-party payers required • Working knowledge of computers • Excellent oral and written communication skills • Excellent customer service and telephone etiquette • Ability to use necessary computer software, applications, equipment, keyboards, fax machines, and telephones • Ability to sit for extended periods • Reading and comprehension ability • Visual acuity within normal range • Ability to communicate effectively • Knowledge of medical terminology preferred • Knowledge of business math preferred • Knowledge of ICD-10 and CPT coding processes preferred • Current knowledge of third-party payer and managed-care billing requirements and contracts • Ability to maintain confidentiality regarding demographic, clinical, and financial information

🏖️ Benefits

• Eight hours of revenue cycle continuing education required annually • Educational programs for mandatory requirements and identified job and personal growth needs • Scheduled weekly hours: 40