West Virginia University Hospitals, Inc.
insurance claims Specialist (JR24-51867)
West Virginia University Hospitals, Inc., Morgantown, West Virginia, United States, 26501
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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: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent.
PREFERREDQUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 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.
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... For full info follow application link.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. Please view Equal Employment Opportunity Posters provided by OFCCP here. The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent.
PREFERREDQUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 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.
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... For full info follow application link.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. Please view Equal Employment Opportunity Posters provided by OFCCP here. The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)