Insurance Claims Specialist HB

wvumedicine; United States; Remote; USD 42,000 - 62,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a dedicated Medical Billing Specialist to submit claims, resolve payer issues, and support revenue cycle activities in a hospital setting. The role emphasizes accuracy, confidentiality, and timely follow-up with third party payers.

Qualified candidates typically have a high school diploma and about one year of medical billing experience, with strong communication skills and knowledge of ICD-10/CPT coding.

Qualifications

• High School diploma or equivalent is required.
• 1 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 submission.
• Adheres to procedures for follow-up with third party payers to exceed department goals.
• Gathers statistics, completes reports and performs other duties as scheduled.
• Organizes daily tasks to achieve productivity and efficiency.
• Complies with HIPAA and protects PHI in claim submissions.
• Contacts third party payers to resolve unpaid claims.
• Uses payer portals to verify status and conduct follow-up.
• Assists with denials investigations and resolutions.
• Participates in mandatory training and improvement initiatives.

Skills

Excellent communication

Computers

Medical terminology

Business math

ICD-10 and CPT coding

Customer service

Tact and diplomacy

Revenue cycle knowledge

Written and oral communication

Education

High School diploma or equivalent

Job description

Welcome! We’re excited you’re considering an opportunity with us!

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• 1. High School diploma or equivalent.

PREFERREDQUALIFICATIONS:

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