Insurance Claim Specialist HB

Insurance Claim Specialist HB – WVU Medicine

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 WVU Medicine hospitals.

• High School diploma or equivalent.

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

• 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 and 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 HIPAA regulations pertaining to PHI and claim submission/follow-up.
• Contacts third party payers to resolve unpaid claims.
• Utilizes payer portals and 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 for 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 accurately and timely.
• Develops and maintains knowledge of 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.

• 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.

• Office type environment.

• 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
• Exempt/Non-Exempt:
  Non-Exempt
• Shift: United States of America
• Company: SYSTEM West Virginia University Health System
• Cost Center: 544 SYSTEM Patient Financial Services