Insurance Claims Specialist HB

WVU Medicine; Core (WV); In loco; USD 34.000 - 44.000; Tempo pieno

Descrizione del lavoro

SYSTEM West Virginia University Health System is seeking a Medical Billing Clerk to manage patient account balances, submit claims to third party payers, and assist with denial management to support hospital financial viability. The role emphasizes accurate follow-up, reporting, and excellent customer service within a vibrant revenue cycle team.

The position requires a High School diploma, 1 year of medical billing/office experience preferred, and strong communication skills to interact with

Competenze

• Excellent oral and written communication skills.
• Knowledge of medical terminology is preferred.
• Knowledge of business math preferred.
• Knowledge of ICD-10 and CPT coding processes preferred.

Mansioni

• 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 as needed.
• Maintains confidentiality per policy when handling patient and demographic information.
• Communicates issues hindering workflow to management promptly.

Conoscenze

Excellent communication

Written communication

Customer service

Computer literacy

Attention to detail

Formazione

High School diploma

Descrizione del lavoro

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:

• High School diploma or equivalent.

Experience

PREFERRED QUALIFICATIONS:

• One (1) year medical billing/medical office experience.

CORE DUTIES AND RESPONSIBILITIES:

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

PHYSICAL REQUIREMENTS:

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

WORKING ENVIRONMENT:

• Office type environment.

Skills And Abilities

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

Additional Job Description

Scheduled Weekly Hours:

40

Exempt/Non-Exempt

Shift:

United States of America (Non-Exempt)

Company

SYSTEM West Virginia University Health System

Cost Center

544 SYSTEM Patient Financial Services