Senior Insurance Claims Specialist

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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. Serves as a resource for co-worker process questions and concerns. 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 Graduate or equivalent.

2. Certified Revenue Cycle Representative (CRCR) Certification through the Healthcare Financial Management Association (HFMA) OR Certified Revenue Cycle Specialist through the American Association of Healthcare Administrative Management (AAHAM) within 90 days of hire.

EXPERIENCE: 

1. Three (3) years medical billing/medical office experience.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Three (3) years medical billing/medical office experience, preferably related to claims billing and insurance follow-up.

 

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 regulations pertaining to PHI and claim submission/follow-up.

7. Contacts third party payers to resolve unpaid claims.

8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up.

9. Assists Patient Access and Care Management with denials investigation and resolution.

10. Accesses and utilizes all necessary computer software, applications and equipment to perform job role.

11. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.

12. Attends department meetings, teleconferences and webcasts as necessary.

13. Researches and processes mail returns and claims rejected by the payer.

14. Reconciles billing account transactions to ensure accurate account information according to established procedures.

15. Processes billing and follow-up transactions in an accurate and timely manner.

16. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.

17. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.

18. Maintains work queue volumes and productivity within established guidelines.

19. Provides excellent customer service to patients, visitors and employees.

20. Participates in performance improvement initiatives as requested.

21. Works with supervisor and manager to develop and exceed annual goals.

22. Maintains confidentiality according to policy