WVU Medicine

Insurance Claims Spec HB

WVU Medicine

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Job Level

Junior

Tech Stack

Ruby

About the role

  • Submits accurate and timely claims to third party payers.
  • Resolves claim edits and account errors prior to claim submission.
  • Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to 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 all HIPAA regulations pertaining to PHI and claim submission/follow-up.
  • Contacts third party payers to resolve unpaid claims.
  • Utilizes payer portals and payer 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 with regard to 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 in an accurate and timely manner.
  • Develops and maintains working knowledge of all 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.

Requirements

  • High School diploma or equivalent.
  • One (1) year medical billing/medical office experience.