Insurance Claim Specialist PB
WVU Medicine, Core, WV, United States
JOB SUMMARY
Responsible for managing patient account balances, including accurate claim submission, compliance with all federal, state, and third‑party billing regulations, timely follow‑up, and assistance with denial management to ensure the financial viability of WVU Medicine hospitals.
CORE DUTIES AND RESPONSIBILITIES
Submit accurate and timely claims to third‑party payers.
Resolve claim edits and account errors prior to claim submission.
Adhere to procedures and timelines for follow‑up with third‑party payers to ensure collections and exceed department goals.
Gather statistics, complete reports, and perform other duties as scheduled or requested.
Organize and execute daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency.
Comply with Notices of Privacy Practices and follow all HIPAA regulations pertaining to PHI and claim submission/follow‑up.
Contact third‑party payers to resolve unpaid claims.
Utilize 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 identified needs for job and personal growth.
Attend department meetings, teleconferences, and webcasts as necessary.
Research and process mail returns and claims rejected by the payer.
Reconcile billing account transactions to maintain accurate account information according to established procedures.
Process billing and follow‑up transactions in an accurate and timely manner.
Develop and maintain working knowledge of all federal, state, and local regulations pertaining to professional billing.
Monitor accounts to facilitate timely follow‑up and payment to 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 supervisor and manager to develop and exceed annual goals.
Maintain confidentiality according to policy when interacting with patients, physicians, families, co‑workers, and the public regarding demographic, clinical, and financial information.
Communicate problems hindering workflow to management in a timely manner.
PHYSICAL REQUIREMENTS
Must be able to sit for extended periods.
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.
Maintain 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.
Understand written and oral communication.
MINIMUM QUALIFICATIONS
Education: High School diploma or equivalent.
Experience: None specified.
PREFERRED QUALIFICATIONS
One (1) year medical billing/medical office experience.
ADDITIONAL JOB DETAILS
Scheduled Weekly Hours: 40
Exempt/Non‑Exempt: Non‑Exempt
Shift: United States of America (Non‑Exempt)
Company: SYSTEM West Virginia University Health System
Cost Center: 544 UHA Patient Financial Services
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CORE DUTIES AND RESPONSIBILITIES
Submit accurate and timely claims to third‑party payers.
Resolve claim edits and account errors prior to claim submission.
Adhere to procedures and timelines for follow‑up with third‑party payers to ensure collections and exceed department goals.
Gather statistics, complete reports, and perform other duties as scheduled or requested.
Organize and execute daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency.
Comply with Notices of Privacy Practices and follow all HIPAA regulations pertaining to PHI and claim submission/follow‑up.
Contact third‑party payers to resolve unpaid claims.
Utilize 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 identified needs for job and personal growth.
Attend department meetings, teleconferences, and webcasts as necessary.
Research and process mail returns and claims rejected by the payer.
Reconcile billing account transactions to maintain accurate account information according to established procedures.
Process billing and follow‑up transactions in an accurate and timely manner.
Develop and maintain working knowledge of all federal, state, and local regulations pertaining to professional billing.
Monitor accounts to facilitate timely follow‑up and payment to 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 supervisor and manager to develop and exceed annual goals.
Maintain confidentiality according to policy when interacting with patients, physicians, families, co‑workers, and the public regarding demographic, clinical, and financial information.
Communicate problems hindering workflow to management in a timely manner.
PHYSICAL REQUIREMENTS
Must be able to sit for extended periods.
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.
Maintain 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.
Understand written and oral communication.
MINIMUM QUALIFICATIONS
Education: High School diploma or equivalent.
Experience: None specified.
PREFERRED QUALIFICATIONS
One (1) year medical billing/medical office experience.
ADDITIONAL JOB DETAILS
Scheduled Weekly Hours: 40
Exempt/Non‑Exempt: Non‑Exempt
Shift: United States of America (Non‑Exempt)
Company: SYSTEM West Virginia University Health System
Cost Center: 544 UHA Patient Financial Services
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