Insurance Claims Specialist PB

WVU Medicine; Core (WV); On-site; USD 32,000 - 42,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a Billing Specialist to manage patient account balances, submit claims, and follow up with third party payers. You will resolve claim edits, support denial management, and help maintain timely cash receipts in a compliant, patient-focused environment.

The role requires a high school diploma and up to 1 year of medical billing experience, with strong communication and computer skills.

Qualifications

• High school diploma or equivalent.
• 1 year medical billing/medical office experience preferred.
• Strong communication and customer service skills.
• Knowledge of HIPAA and privacy regulations.
• Detail-oriented with ability to follow-up and problem-solve.

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 ensure collections.
• Gathers statistics, completes reports and performs other duties as scheduled.
• Organizes and executes daily tasks to achieve productivity and efficiency.
• Maintains HIPAA compliance in PHI and claim processes.
• Contacts third party payers to resolve unpaid claims.
• Uses payer portals and websites to verify claim status and follow-up.
• Assists with denials investigation and resolution.
• Participates in education programs to meet mandatory requirements.
• Attends meetings and webcasts as necessary.
• Researches mail and rejected claims; reconciles billing transactions.
• Maintains knowledge of regulations pertaining to professional billing.
• Monitors accounts for timely follow-up to maximize cash receipts.
• Maintains confidentiality of patient information.

Skills

Excellent communication

Computer skills

Medical terminology

Billing knowledge

ICD-10/CPT knowledge

Customer service

Payer relations

Revenue cycle knowledge

Attention to detail

Teamwork

Education

High School diploma

Tools

Billing software

Payer portals

Job description

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

• High School diploma or equivalent.

Experience

Preferred Qualifications

• 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.

• 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 professional 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

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.

• 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

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.

• 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 UHA Patient Financial Services