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WVU Medicine
WVU Medicine
HealthcareHealthcare Insurance
WVU Medicine is a comprehensive healthcare system affiliated with West Virginia University, serving communities throughout West Virginia through hospitals and regional medical centers. Its network includes J.W. Ruby Memorial Hospital and WVU Medicine Children’s, with services spanning routine care, specialty medicine, and advanced treatments such as robotic heart surgery. Alongside patient care, WVU Medicine supports medical education, clinical research, and community health initiatives, offering opportunities across a large healthcare organization.
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Remote Insurance Claims Specialist at WVU Medicine

WVU Medicine seeks a remote Insurance Claims Specialist to manage hospital billing, submit and follow up on claims, resolve denials, and support patient account resolution. The role contributes to compliant revenue cycle operations and payer collections.

USUnited StatesRemoteFull-timeMiddleSeniorEnglish RequiredClaims Specialist

Description

  • Manage patient account balances through accurate claim submission, regulatory compliance, timely follow-up, and denial resolution
  • Support customers by addressing inquiries and resolving account-related issues
  • Prepare reports and perform clerical tasks as assigned
  • Submit complete and accurate claims to third-party payers on schedule
  • Correct claim edits and account discrepancies before submission
  • Follow up with third-party payers to support collections and departmental objectives
  • Compile statistics and prepare operational reports
  • Plan and prioritize daily work to promote productivity, accountability, and efficiency
  • Apply HIPAA requirements and Notices of Privacy Practices when handling PHI and submitting or following up on claims
  • Contact third-party payers to resolve outstanding claims
  • Use payer portals and websites to check claim status and perform account follow-up
  • Support Patient Access and Care Management with denial research and resolution
  • Participate in required educational programs, department meetings, teleconferences, and webcasts
  • Research and process returned mail and claims rejected by payers
  • Reconcile billing transactions and process billing and follow-up activity accurately and promptly
  • Keep current with federal, state, and local hospital billing regulations
  • Monitor accounts to ensure prompt follow-up and payment while maximizing cash receipts
  • Maintain assigned work queue volumes and productivity within established standards
  • Deliver courteous and effective service to patients, visitors, and employees
  • Contribute to performance improvement efforts
  • Partner with the supervisor and manager to establish and exceed annual objectives
  • Protect the confidentiality of demographic, clinical, and financial information
  • Escalate workflow issues to management promptly

Requirements

  • High school diploma or equivalent
  • Preferred: one year of medical billing or medical office experience
  • Strong verbal and written communication skills
  • Working knowledge of computers
  • Excellent customer service skills and telephone etiquette
  • Ability to use tact and diplomacy when interacting with others
  • Preferred: familiarity with medical terminology
  • Preferred: knowledge of business mathematics
  • Preferred: knowledge of ICD-10 and CPT coding procedures
  • Knowledge of revenue cycle operations, third-party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement practices
  • Ability to understand written and spoken instructions
  • Ability to remain seated for extended periods
  • Ability to read and comprehend information
  • Visual acuity within the normal range
  • Ability to communicate effectively
  • Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment

Benefits

  • Access to educational programs supporting mandatory requirements and identified professional or personal development needs
  • Reasonable accommodations may be provided so individuals with disabilities can perform essential job functions

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