Clinical Denials Specialist

WVU Medicine

3d•Onsite

About The Position

This position is responsible for managing accounts receivable related to denied claims to ensure the financial viability of the WVU Medicine hospitals. This includes but is not limited to, denial investigation, follow-up with insurance companies, billing, auditors and clinics/hospital departments, non-clinical appeal writing, accurate and timely account adjustments all while ensuring compliance with all federal, state, third-party billing regulations and contract agreements. The role requires excellent customer service, oral and written communication skills and involves working with leadership and other team members to achieve best in class revenue cycle processes.

Requirements

High School diploma or equivalent.
One (1) year of training in medical billing, coding, insurance processing, or other related experience.

Nice To Haves

Associate degree in related field
Knowledge and experience with EPIC medical billing
Experience with Microsoft Excel/Word
Experience with hospital billing.
Knowledge of medical terminology preferred.
Prior experience with Microsoft Office Suite software applications, including, but not limited to, Word, Excel, Access, Power Point and Outlook is preferred.
Ability to type at least 35 WPM preferred.

Responsibilities

Accurately triage and route claims to work queues by maintaining a working knowledge of system hospital/clinic departments, procedures and payer appeal processes and deadlines
Follow up with third party payers to clarify payment remit issues, ensure timely appeal receipt/process/resolution; adheres to appropriate procedures and timelines and escalate payer behavior issues to management
Utilizes payer portals and payer websites to verify appeal status and conduct account follow-up, contacting payers by telephone when needed
Composes administrative, non-clinical appeals as directed by leadership. Organizes and manages appeal letter submissions via mail or other portals.
Develops and maintains working knowledge of all federal, state, and local regulations pertaining to hospital billing compliance regulations.
Maintains work queue volumes and productivity within established standards. Adhere to timely filing guidelines for work queue prioritization.
Post adjustments as directed or by following department SOP, ensuring accurate and timely processing, and validating based on contract pricing/payer models.
Manages and distributes incoming mail in an accurate and timely manner; includes Epic documentation, logging incoming correspondence, uploading to document warehouse and routing mis-directed mail; processes outgoing certified mail.
Communicates problems hindering workflow to management in a timely manner; provide suggestions to increase workflow efficiency.
Participates in educational programs to meet mandatory requirements and identified needs regarding job and personal growth.
Attends department meetings, teleconferences, and webinars as necessary or directed.
Provides excellent customer service to patients, employees, vendors, and auditors.
Utilizes Microsoft Office or other applications as needed to complete job functions, specific reporting, or project management.