Insurance Claims Specialist

Responsible for managing patient account balances including accurate claim submission, compliance with 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. 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 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. Scheduled weekly hours: 40. #J-18808-Ljbffr