Insurance Claims Specialist
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Job Description
Part-time remote Insurance Claims Specialist managing hospital claims, billing accounts, denials, and payer follow-up for WVU Medicine. Supporting revenue cycle operations and patient financial services.
Responsibilities:
- Manage patient account balances, including claim submission, regulatory compliance, timely follow-up, and denial management
- Submit accurate and timely claims to third-party payers
- Resolve claim edits, account errors, unpaid claims, rejected claims, and billing issues
- Use payer portals and websites to verify claim status and conduct account follow-up
- Assist Patient Access and Care Management with denial investigation and resolution
- Gather statistics, complete reports, and perform clerical duties
- Reconcile billing account transactions and process billing and follow-up transactions
- Monitor accounts to facilitate timely follow-up and maximize cash receipts
- Maintain work queue volumes and productivity within established guidelines
- Provide customer service to patients, visitors, and employees
- Attend department meetings, teleconferences, and webcasts as necessary
- Maintain confidentiality of demographic, clinical, and financial information
- Communicate workflow problems to management and work with supervisors and managers to achieve annual goals
Requirements:
- High School diploma or equivalent
- Excellent oral and written communication skills
- Working knowledge of computers
- Excellent customer service and telephone etiquette
- Ability to use tact and diplomacy in dealing with others
- Ability to understand written and oral communication
- Ability to sit for extended periods of time
- Reading and comprehension ability
- Visual acuity within normal range
- Ability to communicate effectively
- Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment
- Knowledge of medical terminology preferred
- Knowledge of business math preferred
- Knowledge of ICD-10 and CPT coding processes preferred
- Knowledge of revenue cycle operations, third-party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures
- One year of medical billing/medical office experience preferred
Benefits:
- Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
- Performance improvement initiatives
- Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions
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