Insurance Claims Specialist HB

Claims SpecialistClaims SpecialistFull TimeRemoteMid LevelTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

28 days ago

Salary

Not specified

Seniority

Mid Level

Bachelor Degree2 yrs expEnglishCpt CodingIcd-10

Job Description

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full.  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 PREFERRED QUALIFICATIONS EXPERIENCE: 1. 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. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 11. Attends department meetings, teleconferences and webcasts as necessary. 12. Researches and processes mail returns and claims rejected by the payer. 13. Reconciles billing account transactions to ensure accurate account information according to established procedures. 14. Processes billing and follow-up transactions in an accurate and timely manner. 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 17. Maintains work queue volumes and productivity within established guidelines. 18. Provides excellent customer service to patients, visitors and employees. 19. Participates in performance improvement initiatives as requested. 20. Works with supervisor and manager to develop and exceed annual goals. 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 22. 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. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. 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. 1. Office type environment. SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of business math preferred. 5. Knowledge of ICD-10 and CPT coding processes preferred. 6. Excellent customer service and telephone etiquette. 7. Ability to use tact and diplomacy in dealing with others. 8. 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. 9. Ability to understand written and oral communication. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 SYSTEM Patient Financial Services

Job Requirements

  • :
  • EDUCATION, CERTIFICATION, AND/OR LICENSURE:
  • 1. High School diploma or equivalent.

Related Categories

Related Job Pages

More Claims Specialist Jobs

Great American Insurance Group logo

Senior Claims Specialist - CA Workers' Compensation

Great American Insurance Group

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast. Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths.

Claims Specialist28 days ago
Full TimeRemoteTeam 4,738

As a Senior Claims Specialist, you will investigate and adjust workers' compensation claims, analyze coverage, negotiate settlements, and prepare reports, while working collaboratively with internal and external stakeholders.

Utah + 10 moreAll locations: Utah, Texas, Idaho, Nevada, Oregon, Arizona, Oklahoma, Colorado, California, New Mexico, District Of Columbia
$105K - $120K / year
Claims Specialist28 days ago
Full TimeRemoteTeam 10,001+Since 1931H1B Sponsor

Auto Claims Adjuster investigating automobile accidents at National General

United States
$50K - $104.1K / year
Sedgwick logo

Claims Examiner – Workers Comp, Southeast State Exp Needed

Sedgwick

Sedgwick, headquartered in Memphis, Tennessee, provides a global clientele with technology-enabled risk and benefits solutions. Distinguished as an Employer of

Claims Specialist28 days ago
Full TimeRemoteTeam 10,001

Claims Examiner handling workers compensation claims for a global leader

Florida
Sedgwick logo

Liability Claims Examiner – GL & Auto, BI & PD

Sedgwick

Sedgwick, headquartered in Memphis, Tennessee, provides a global clientele with technology-enabled risk and benefits solutions. Distinguished as an Employer of

Claims Specialist28 days ago
Full TimeRemoteTeam 10,001

Analyzing and processing claims for a global industry leader in a remote role

New Jersey
$66K - $85K / year