Insurance Claims Specialist

WVU; Uniontown (Fayette County); On-site; USD 40,000 - 65,000; Full time

Job summary

Join a leading health system as an Insurance Claims Specialist, where you will play a crucial role in managing patient accounts and ensuring timely processing of claims. This position offers an opportunity to work in a collaborative environment, focusing on patient interactions and third-party payer communications. You will be responsible for reviewing and correcting billing edits, resolving unpaid accounts, and maintaining accurate records. If you have a keen eye for detail and a passion for healthcare, this role is perfect for you.

Qualifications

• High school diploma or equivalent required.
• Previous hospital billing and/or credit and collection experience preferred.

Responsibilities

• Performs claims processing to third party payer according to payer guidelines.
• Works follow-up reports thoroughly within the month.
• Communicates problems hindering workflow to management in a timely manner.

Skills

Excellent oral and written communication skills

Basic knowledge of medical terminology

General knowledge of accounts receivable and collections procedures

Education

High school diploma or equivalent

Job description

Insurance Claims Specialist page is loaded

Insurance Claims Specialist

Apply locations Uniontown Hospital (UNTWN) time type Full time posted on Posted 2 Days Ago job requisition id JR25-09056

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.

Responsible for the process of patient account review, correction, adjustment, and filing to third party payers and/or patients. Works directly with patients and third party payers as it relates to information distribution.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent.
2. State criminal background check and Federal (if applicable), as required for regulated areas.

PREFERRED QUALIFICATIONS :

EXPERIENCE:
1. Previous hospital billing and/or credit and collection 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. Performs claims processing to third party payer according to payer guidelines.
2. Reviews and corrects billing edits prior to submitting claims.
3. Reviews edits to ensure proper billing and verifies edits with the appropriate Department leaders, if needed.
4. Works denials thoroughly and timely with little back-log.
5. Performs follow up on account, working with third party payers, patient, employer, and physician office to resolve unpaid or underpaid accounts. Works follow-up reports thoroughly within the month.
6. Communicates problems hindering workflow to management in a timely manner.
7. Posts copays collected at Medical Offices to vouchers.Maintains unassigned payments.
8. Processes collections accounts.
9. Processes patient and insurance refund documentation.

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. Prolonged periods of sitting.
2. Manual dexterity required to operate standard office 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. Standard office environment.

SKILLS AND ABILITIES:

1. Excellent oral and written communication skills.
2. Basic knowledge of medical terminology.
3. General knowledge of accounts receivable and collections procedures.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

UNTWN Uniontown Hospital

Cost Center:

126 UNTWN HVI Cardiology

Address:

500 W Berkeley StreetUniontownPennsylvania

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Welcome

About Us

The West Virginia University Health System, West Virginia's largest health system with more than 2,700 beds is the state’s largest private employer, is comprised of more than 20 hospitals, including a children's hospital and five institutes, all anchored by a 700-bed academic medical center in Morgantown, West Virginia. Learn more about WVU Medicine here: https://wvumedicine.org/about/