Insurance Claims Specialist PB

WVU Medicine•Home Work - Monongalia County WV (Local), WV

About The Position

The Insurance Claims Specialist manages patient account balances through accurate claim submission, compliance with federal, state, and third-party billing regulations, timely follow-up, and assistance with denial management to support the financial viability of WVU Medicine hospitals. The role provides customer support and resolves issues raised through customer inquiries, using strong oral and written communication skills. It also supports department operations by completing reports and clerical duties as needed and works with leadership and team members to achieve effective revenue cycle operations.

Requirements

High school diploma or equivalent.
Excellent oral and written communication skills.
Working knowledge of computers.
Excellent customer service skills and telephone etiquette.
Ability to use tact and diplomacy in dealing with others.
Ability to understand written and oral communication.
Ability to maintain knowledge of revenue cycle operations, third-party reimbursement, and medical terminology, including payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures.
Ability to sit for extended periods.
Reading and comprehension ability.
Visual acuity within the normal range.
Ability to communicate effectively.
Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.

Nice To Haves

One year of medical billing or medical office experience.
Knowledge of medical terminology.
Knowledge of business math.
Knowledge of ICD-10 and CPT coding processes.

Responsibilities

Submit accurate and timely claims to third-party payers.
Resolve claim edits and account errors before claim submission.
Follow appropriate procedures and timelines with third-party payers to support collections and meet department goals.
Gather statistics, complete reports, and perform other duties as scheduled or requested.
Organize and prioritize daily tasks to support productivity, accountability, and efficiency.
Comply with Notices of Privacy Practices and HIPAA regulations related to protected health information and claim submission and 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.
Participate in educational programs to meet mandatory requirements and support job-related and personal growth.
Attend department meetings, teleconferences, and webcasts as necessary.
Research and process returned mail and claims rejected by payers.
Reconcile billing account transactions to ensure accurate account information under established procedures.
Process billing and follow-up transactions accurately and promptly.
Develop and maintain working knowledge of federal, state, and local regulations pertaining to professional billing.
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 as requested.
Work with the supervisor and manager to develop and exceed annual goals.
Maintain confidentiality when interacting with patients, physicians, families, coworkers, and the public regarding demographic, clinical, and financial information.
Communicate workflow issues to management in a timely manner.