Evernorth Health Services is hiring an Insurance Claims Specialist HB. In this role, you will be 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 the WVU Medicine hospitals.
What You'll Do
- Submit accurate and timely claims to third party payers.
- Resolve claim edits and account errors prior to claim submission.
- Adhere to appropriate 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 payer websites to verify claim status and conduct account follow-up.
- Assist Patient Access and Care Management with denials investigation and resolution.
- Research and process mail returns and claims rejected by the payer.
- Reconcile billing account transactions to ensure accurate account information according to established procedures.
- Process billing and follow-up transactions in an accurate and timely manner.
- Develop and maintain a working knowledge of all federal, state, and local regulations pertaining to hospital 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 your 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/financial information.
- Communicate problems hindering workflow to management in a timely manner.
What We're Looking For
- High School diploma or equivalent.
Nice to Have
- One (1) year of medical billing or medical office experience.
- Knowledge of medical terminology.
- Knowledge of business math.
- Knowledge of ICD-10 and CPT coding processes.
Technical Stack
- Payer portals
- Payer websites
Team & Environment
You will work with leadership and other team members to achieve best-in-class revenue cycle operations.
Work Mode
This role is onsite.
