West Virginia University Health System is hiring an Insurance Claims Specialist HB to manage patient account balances and ensure the financial viability of our hospitals. You'll be responsible for accurate claim submission, compliance with all federal, state, and third-party billing regulations, and timely follow-up and denial management.
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.
- Gather statistics, complete reports, and perform other scheduled or requested clerical duties.
- Organize and execute daily tasks in priority to achieve optimal productivity and efficiency.
- Comply with Notices of Privacy Practices and follow all HIPAA regulations pertaining to PHI.
- 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 denials investigation and resolution.
- Research and process mail returns and claims rejected by the payer.
- Reconcile billing account transactions to ensure accurate account information.
- Process billing and follow-up transactions accurately and promptly.
- Develop and maintain a working knowledge of all federal, state, and local hospital billing regulations.
- Monitor accounts to facilitate timely follow-up 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 and educational programs.
- Attend department meetings, teleconferences, and webcasts as necessary.
- Work with supervisor and manager to develop and exceed annual goals.
- Maintain confidentiality when interacting with patients, physicians, families, co-workers, and the public.
- Communicate workflow problems 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.
Team & Environment
You will work with leadership and other team members to achieve best-in-class revenue cycle operations.
Work Mode
This is an onsite role.
West Virginia University Health System is an equal opportunity employer.
