Insurance Claims Specialist HB

Responsible for

• Manages patient account balances including accurate claim submission
• Complies with all federal/state and third party billing regulations
• Timely follow-up and assistance with denial management
• Achieves financial viability of WVU Medicine hospitals

Supports

• Customer service and oral/written communication skills
• Provides support and resolves customer inquiries
• Completes reports and clerical duties as needed
• Works with leadership and other team members

Core Duties and Responsibilities

• Sets up and submits accurate and timely claims to third party payers
• Resolves claim edits and account errors before submission
• Fulfills follow-up with third party payers to ensure collections
• Collects statistics, completes reports, and performs other duties as scheduled
• Organizes and prioritizes daily tasks to achieve optimal productivity
• Complies with Notices of Privacy Practices and HIPAA regulations
• 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 job and personal growth needs
• 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 accuracy
• Processes billing and follow-up transactions accurately and timely
• Maintains working knowledge of all relevant federal, state, and local regulations
• Maintains accounts to facilitate timely follow-up and payment
• Communicates problems hindering workflow to management
• Maintains confidentiality according to policy
• Communicates effectively with patients, visitors, and employees
• Participates in performance improvement initiatives as requested
• Works with supervisor and manager to develop and exceed annual goals

Physical Requirements

• Sit for extended periods of time
• Read and comprehend ability
• Visual acuity within normal range
• 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

Additional Job Description

• Scheduled Weekly Hours: 40
• Exempt/Non-Exempt Shift: United States of America (Non-Exempt)
• Cost Center: 544 SYSTEM Patient Financial Services
• Company: SYSTEM West Virginia University Health System