WVU Medicine
Insurance Claim Specialist HB – WVU Medicine
Responsible for managing patient account balances including accurate claim submission, compliance with federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of WVU Medicine hospitals.
Minimum Qualifications
High School diploma or equivalent.
Preferred Qualifications
One (1) year medical billing/medical office experience.
CORE DUTIES AND RESPONSIBILITIES
Submits accurate and timely claims to third party payers.
Resolves claim edits and account errors prior to claim submission.
Adheres to procedures and timelines for follow-up with third party payers to ensure collections and exceed department goals.
Gathers statistics, completes reports, and performs other duties as scheduled or requested.
Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
Complies with Notices of Privacy Practices and follows HIPAA regulations pertaining to PHI and claim submission/follow-up.
Contacts third party payers to resolve unpaid claims.
Utilizes payer portals and websites to verify claim status and conduct account follow-up.
Assists Patient Access and Care Management with denials investigation and resolution.
Participates in educational programs to meet mandatory requirements and identified needs for job and personal growth.
Attends department meetings, teleconferences, and webcasts as necessary.
Researches and processes mail returns and claims rejected by the payer.
Reconciles billing account transactions to ensure accurate account information according to established procedures.
Processes billing and follow-up transactions accurately and timely.
Develops and maintains knowledge of federal, state, and local regulations pertaining to hospital billing.
Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
Maintains work queue volumes and productivity within established guidelines.
Provides excellent customer service to patients, visitors, and employees.
Participates in performance improvement initiatives as requested.
Works with supervisor and manager to develop and exceed annual goals.
Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information.
Communicates problems hindering workflow to management in a timely manner.
PHYSICAL REQUIREMENTS
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.
WORKING ENVIRONMENT
Office type environment.
SKILLS AND ABILITIES
Excellent oral and written communication skills.
Working knowledge of computers.
Knowledge of medical terminology preferred.
Knowledge of business math preferred.
Knowledge of ICD-10 and CPT coding processes preferred.
Excellent customer service and telephone etiquette.
Ability to use tact and diplomacy in dealing with others.
Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures.
Ability to understand written and oral communication.
ADDITIONAL JOB DESCRIPTION
Scheduled Weekly Hours: 40
Exempt/Non-Exempt: Non-Exempt
Shift: United States of America
Company: SYSTEM West Virginia University Health System
Cost Center: 544 SYSTEM Patient Financial Services
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Responsible for managing patient account balances including accurate claim submission, compliance with federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of WVU Medicine hospitals.
Minimum Qualifications
High School diploma or equivalent.
Preferred Qualifications
One (1) year medical billing/medical office experience.
CORE DUTIES AND RESPONSIBILITIES
Submits accurate and timely claims to third party payers.
Resolves claim edits and account errors prior to claim submission.
Adheres to procedures and timelines for follow-up with third party payers to ensure collections and exceed department goals.
Gathers statistics, completes reports, and performs other duties as scheduled or requested.
Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
Complies with Notices of Privacy Practices and follows HIPAA regulations pertaining to PHI and claim submission/follow-up.
Contacts third party payers to resolve unpaid claims.
Utilizes payer portals and websites to verify claim status and conduct account follow-up.
Assists Patient Access and Care Management with denials investigation and resolution.
Participates in educational programs to meet mandatory requirements and identified needs for job and personal growth.
Attends department meetings, teleconferences, and webcasts as necessary.
Researches and processes mail returns and claims rejected by the payer.
Reconciles billing account transactions to ensure accurate account information according to established procedures.
Processes billing and follow-up transactions accurately and timely.
Develops and maintains knowledge of federal, state, and local regulations pertaining to hospital billing.
Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
Maintains work queue volumes and productivity within established guidelines.
Provides excellent customer service to patients, visitors, and employees.
Participates in performance improvement initiatives as requested.
Works with supervisor and manager to develop and exceed annual goals.
Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information.
Communicates problems hindering workflow to management in a timely manner.
PHYSICAL REQUIREMENTS
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.
WORKING ENVIRONMENT
Office type environment.
SKILLS AND ABILITIES
Excellent oral and written communication skills.
Working knowledge of computers.
Knowledge of medical terminology preferred.
Knowledge of business math preferred.
Knowledge of ICD-10 and CPT coding processes preferred.
Excellent customer service and telephone etiquette.
Ability to use tact and diplomacy in dealing with others.
Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures.
Ability to understand written and oral communication.
ADDITIONAL JOB DESCRIPTION
Scheduled Weekly Hours: 40
Exempt/Non-Exempt: Non-Exempt
Shift: United States of America
Company: SYSTEM West Virginia University Health System
Cost Center: 544 SYSTEM Patient Financial Services
#J-18808-Ljbffr