Insurance Claims Specialist

WVU Medicine; Oregon; Hybrid; USD 38,000 - 60,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a Patient Financial Services representative to manage patient account balances, submit accurate claims, follow up with payers, and assist with denial management. The role emphasizes HIPAA compliance, customer service, and timely reporting within a hospital billing context.

Ideal candidates will have a high school diploma and preferably one year of medical billing experience, with strong communication and math skills to support revenue

Qualifications

• High School diploma or equivalent required.
• One year medical billing/medical office experience preferred.

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 maximize collections.
• Gathers statistics, completes reports and performs clerical duties.
• Organizes daily tasks to achieve productivity and efficiency.
• Complies with HIPAA and follows PHI and claim submission/follow-up rules.
• Contacts payers to resolve unpaid claims.
• Uses payer portals and payer websites to verify claim status.
• Assists with denials investigation and resolution.
• Participates in educational programs for mandatory requirements and growth.
• Attends department meetings, teleconferences and webcasts.
• Researches mail returns and claims rejected by payers.
• Reconciles billing transactions per procedures.
• Processes billing and follow-up transactions accurately and timely.
• Develops knowledge of federal/state/local regulations for hospital billing.
• Monitors accounts to ensure timely follow-up and payments.
• Maintains queue volumes and productivity within guidelines.
• Provides excellent customer service to patients, visitors and employees.
• Participates in performance improvement initiatives.
• Works with supervisor to develop and exceed annual goals.
• Maintains confidentiality of patient information.
• Communicates workflow problems to management.

Skills

Excellent oral and written comms

Computers proficiency

Medical terminology

Business math

ICD-10 and CPT coding

Customer service

Telephone etiquette

Tact and diplomacy

Revenue cycle knowledge

Education

High School diploma or equivalent

Job description

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