Insurance Claims Specialist

WVU Medicine; Charleston (WV); Vor Ort; USD 42.000 - 64.000; Vollzeit

Zusammenfassung

SYSTEM West Virginia University Health System in Charleston, WV is seeking a Billing Specialist to manage patient account balances, submit claims, and follow up with third-party payers. The role emphasizes compliance with HIPAA and state/federal regulations, accurate billing, and denial management to support the WVU Medicine hospitals.

You will collaborate with Patient Access and Care Management, prepare reports, and help meet department goals through efficient daily tasks and strong customer

Qualifikationen

• High School diploma or equivalent required.
• At least 1 year medical billing/office experience preferred.
• Knowledge of HIPAA and privacy practices helpful.

Aufgaben

• Submit accurate, timely claims to third-party payers.
• Resolve claim edits and account errors before submission.
• Follow up with payers to ensure collections and meet goals.
• Gather statistics, generate reports, perform duties as assigned.
• Prioritize daily tasks for productivity and efficiency.
• Ensure HIPAA compliance regarding PHI and submissions.
• Contact payers to resolve unpaid claims.
• Use payer portals to verify status and follow up.
• Assist with denial investigations and resolutions.
• Participate in required training programs.
• Attend department meetings and webinars.
• Reconcile billing transactions to maintain accuracy.
• Process billing and follow-up transactions timely.
• Maintain knowledge of regulations governing hospital billing.
• Monitor accounts to optimize cash receipts.
• Maintain queue volumes within guidelines.
• Provide excellent customer service to patients and staff.
• Contribute to performance improvement initiatives.
• Collaborate with supervisor to meet annual goals.
• Maintain confidentiality of patient data.
• Report workflow issues to management.

Kenntnisse

Communication skills

Customer service

Telephone etiquette

Medical terminology

Ausbildung

High School diploma or equivalent

Tools

Payer portals

Billing software

Jobbeschreibung

Below, you’ll find other important information about this position.

Responsible for managing patient account balances including accurate claim submission, compliance will 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. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations.

MINIMUM QUALIFICATIONS

:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. High School diploma or equivalent.

PREFERRED QUALIFICATIONS

:EXPERIENCE:1. One (1) year medical billing/medical office experience.

CORE DUTIES AND RESPONSIBILITIES:

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• 1. Submits accurate and timely claims to third party payers.
• 2. Resolves claim edits and account errors prior to claim submission.
• 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals.
• 4. Gathers statistics, completes reports and performs other duties as scheduled or requested.
• 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
• 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up.
• 7. Contacts third party payers to resolve unpaid claims.
• 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up.
• 9. Assists Patient Access and Care Management with denials investigation and resolution.
• 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
• 11. Attends department meetings, teleconferences and webcasts as necessary.
• 12. Researches and processes mail returns and claims rejected by the payer.
• 13. Reconciles billing account transactions to ensure accurate account information according to established procedures.
• 14. Processes billing and follow-up transactions in an accurate and timely manner.
• 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.
• 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
• 17. Maintains work queue volumes and productivity within established guidelines.
• 18. Provides excellent customer service to patients, visitors and employees.
• 19. Participates in performance improvement initiatives as requested.
• 20. Works with supervisor and manager to develop and exceed annual goals.
• 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information.
• 22. Communicates problems hindering workflow to management in a timely manner.

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must be able to sit for extended periods of time.
2. Must have reading and comprehension ability.
3. Visual acuity must be within normal range.
4. Must be able to communicate effectively.
5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment.

WORKING ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment.

SKILLS AND ABILITIES:

• 1. Excellent oral and written communication skills.
• 2. Working knowledge of computers.
• 3. Knowledge of medical terminology preferred.
• 4. Knowledge of business math preferred.
• 5. Knowledge of ICD-10 and CPT coding processes preferred.
• 6. Excellent customer service and telephone etiquette.
• 7. Ability to use tact and diplomacy in dealing with others.
• 8. 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.
• 9. Ability to understand written and oral communication.

Additional Job Description:Scheduled Weekly Hours:40

Shift:Exempt/Non-Exempt:United States of America (Non-Exempt)

Company:SYSTEM West Virginia University Health System

Cost Center:544 SYSTEM Patient Financial Services