SYSTEM West Virginia University Health System
InsuranceClaimSpecialist
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Insurance Claim Specialist at SYSTEM West Virginia University Health System. Skills: Claim submission, Revenue cycle operations, Third party reimbursement, Medical billing. Managing patient account balances. Accurate claim submission”
What You'll Achieve.
Ensure the financial viability of the WVU Medicine hospitals; Exceed department goals; Achieve optimal productivity, accountability and efficiency; Maximize cash receipts; Maintain work queue volumes and productivity within established guidelines; Develop and exceed annual goals
Industry & Context.
Resolves claim edits and account errors prior to claim submission; Contacts third party payers to resolve unpaid claims; Assists Patient Access and Care Management with denials investigation and resolution; Researches and processes mail returns and claims rejected by the payer
Must be able to sit for extended periods of time, Must have reading and comprehension ability, Visual acuity must be within normal range, Must be able to communicate effectively, Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment
What They're Looking For.
Must Have
High School diploma or equivalent
Nice to Have
One (1) year medical billing/medical office experience, Knowledge of medical terminology, Knowledge of business math, Knowledge of ICD-10 and CPT coding processes
What You'll Do.
Managing patient account balances
Accurate claim submission
Compliance with all federal/state and third party billing regulations
Assistance with denial management
Ensuring the financial viability of the WVU Medicine hospitals
Providing customer support
Resolving issues that arise from customer inquiries
Performing clerical duties
Achieving best in class revenue cycle operations
Submitting accurate and timely claims to third party payers
Resolving claim edits and account errors prior to claim submission
Adhering to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals
Performing other duties as scheduled or requested
Organizing and executing daily tasks in appropriate priority to achieve optimal productivity
accountability and efficiency
Complying with Notices of Privacy Practices
Following all HIPAA regulations pertaining to PHI and claim submission/follow-up
Contacting third party payers to resolve unpaid claims
Utilizing payer portals and payer websites to verify claim status and conduct account follow-up
Assisting Patient Access and Care Management with denials investigation and resolution
Participating in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
Attending department meetings
teleconferences and webcasts as necessary
Researching and processing mail returns and claims rejected by the payer
Reconciling billing account transactions to ensure accurate account information according to established procedures
Processing billing and follow-up transactions in an accurate and timely manner
Developing and maintaining working knowledge of all federal
state and local regulations pertaining to professional billing
Monitoring accounts to facilitate timely follow-up and payment to maximize cash receipts
Maintaining work queue volumes and productivity within established guidelines
Providing excellent customer service to patients
visitors and employees
Participating in performance improvement initiatives as requested
Working with supervisor and manager to develop and exceed annual goals
Maintaining confidentiality according to policy when interacting with patients
co-workers and the public regarding demographic/clinical/financial information
Communicating problems hindering workflow to management in a timely manner
How You'll Work.
Team & Collaboration
Works with leadership and other team members to achieve best in class revenue cycle operations; Assists Patient Access and Care Management with denials investigation and resolution; Attends department meetings, teleconferences and webcasts as necessary; Works with supervisor and manager to develop and exceed annual goals; Communicates problems hindering workflow to management in a timely manner
Communication Scope
Excellent oral and written communication skills; Ability to understand written and oral communication
Full 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_ :** **EDUCATION, CERTIFICATION, AND/OR LICENSURE:** 1\. High School diploma or equivalent. ** _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 regula
Applying for this Insurance Claim Specialist role?
Most applicants get filtered before a human reads their resume. See if yours makes the cut.
How to Apply on Workday
- Workday has a multi-step form — save your progress after every section.
- "Apply With LinkedIn" can fail or lose data; manual entry is more reliable.
- Watch for the "Submit for Review" final step — hitting "Save" alone does not submit.
- Job requisition numbers are useful when following up with HR by email.
ANONYMOUS · UNFILTERED
What do employees actually say about SYSTEM West Virginia University Health System?
Real rants from real employees. Read before you apply.