Insurance Service Agent
Outdoorsy
Insurance Claims Specialist
WVU Medicine
full-time
Posted on:
Location: Virginia, West Virginia • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
Tech Stack
Ruby
About the role
- Manage patient account balances, accurate claim submission, timely follow-up, and denial management to ensure financial viability of WVU Medicine hospitals.
- Submit accurate and timely claims to third party payers.
- Resolve claim edits and account errors prior to claim submission.
- Follow appropriate procedures and timelines for follow-up with third party payers to ensure collections and exceed department goals.
- Gather statistics, complete reports and perform clerical duties as needed.
- Organize and execute daily tasks to achieve optimal productivity, accountability and efficiency.
- Comply with Notices of Privacy Practices and HIPAA regulations pertaining to PHI and claim submission/follow-up.
- Contact third party payers to resolve unpaid claims and utilize payer portals/websites to verify claim status and conduct account follow-up.
- Assist Patient Access and Care Management with denials investigation and resolution.
- Research and process mail returns and claims rejected by the payer.
- Reconcile billing account transactions and process billing and follow-up transactions accurately and timely.
- Monitor accounts to facilitate timely follow-up and payment to maximize cash receipts; maintain work queue volumes and productivity.
- Provide excellent customer service to patients, visitors and employees; communicate problems hindering workflow to management.
- Participate in educational programs, department meetings, performance improvement initiatives, and work with supervisor and manager to develop and exceed annual goals.
Requirements
- High School diploma or equivalent.
- One (1) year medical billing/medical office experience (preferred).
- Excellent customer service, 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).
- Ability to use tact and diplomacy in dealing with others.
- Maintains knowledge of revenue cycle operations, third party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures.
- Ability to understand written and oral communication.
- Knowledge of HIPAA regulations and Notices of Privacy Practices.
- Physical requirements: able to sit for extended periods, reading and comprehension ability, normal visual acuity, effective communication, manual dexterity to operate keyboards and business equipment.
