Insurance Claims Specialist

Insurance Claims Specialist HB

Location: Remote — United States
Work Arrangement: 100% Remote
Employment Type: Full-time
Scheduled Hours: 40 hours per week

Job Description: 

Position Summary

The Insurance Claims Specialist is responsible for managing patient account balances, including accurate claim submission, compliance with federal, state, and third-party billing regulations, timely follow-up, and assistance with denial management to support the financial viability of WVU Medicine hospitals.

The role provides customer support and resolves issues arising from customer inquiries while supporting departmental operations through reporting and clerical duties. The Insurance Claims Specialist works with leadership and other team members to achieve best-in-class revenue cycle operations.

Responsibilities

• Submit accurate and timely claims to third-party payers.
• Resolve claim edits and account errors before claim submission.
• Follow appropriate procedures and timelines for third-party payer follow-up to support collections and exceed department goals.
• Gather statistics, complete reports, and perform other scheduled or requested duties.
• Organize and prioritize daily tasks to achieve productivity, accountability, and efficiency.
• Comply with Notices of Privacy Practices and all Health Insurance Portability and Accountability Act (HIPAA) regulations concerning protected health information and claim submission and follow-up.
• Contact third-party payers to resolve unpaid claims.
• Use payer portals and websites to verify claim status and conduct account follow-up.
• Assist Patient Access and Care Management with denial investigation and resolution.
• Participate in educational programs to meet mandatory requirements and identified professional development needs.
• Attend department meetings, teleconferences, and webcasts as necessary.
• Research and process returned mail and claims rejected by payers.
• Reconcile billing account transactions to ensure accurate account information according to established procedures.
• Process billing and follow-up transactions accurately and in a timely manner.
• Maintain working knowledge of federal, state, and local regulations applicable to hospital billing.
• Monitor accounts to facilitate timely follow-up and payment and maximize cash receipts.
• Maintain work queue volumes and productivity within established guidelines.
• Provide excellent customer service to patients, visitors, and employees.
• Participate in performance improvement initiatives as requested.
• Work with supervisors and managers to develop and exceed annual goals.
• Maintain confidentiality when interacting with patients, physicians, families, coworkers, and the public regarding demographic, clinical, and financial information.
• Communicate workflow issues to management in a timely manner.

Minimum Qualifications

Education

• High school diploma or equivalent.

Preferred Experience

• 1 year of medical billing or medical office experience.

Skills and Abilities

• Excellent oral and written communication skills.
• Working knowledge of computers.
• Knowledge of medical terminology preferred.
• Knowledge of business mathematics preferred.
• Knowledge of International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) coding processes preferred.
• Excellent customer service and telephone etiquette.
• Ability to use tact and diplomacy when dealing with others.
• Working knowledge of revenue cycle operations, third-party reimbursement, and medical terminology.
• Knowledge of payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures.
• Ability to understand written and oral communication.

Physical Requirements

• Ability to sit for extended periods.
• Reading and comprehension ability.
• Visual acuity within normal range.
• Ability to communicate effectively.
• Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.

Work Environment

• Office-type work environment.
• Remote work location as designated by the position.

Additional Information

Work Schedule: 40 hours per week
Employment Classification: Non-exempt
Company: System West Virginia University Health System
Cost Center: 544 — System Patient Financial Services