What are the responsibilities and job description for the Insurance Claims Specialist position at WVU Medicine?
Responsible for the process of patient account review, correction, adjustment, and filing to third party payers and / or patients. Works directly with patients and third party payers as it relates to information distribution.
MINIMUM QUALIFICATIONS :
EDUCATION, CERTIFICATION, AND / OR LICENSURE :
1. High school diploma or equivalent.
2. State criminal background check and Federal (if applicable), as required for regulated areas.
PREFERRED QUALIFICATIONS :
EXPERIENCE :
1. Previous hospital billing and / or credit and collection 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. Performs claims processing to third party payer according to payer guidelines.
2. Reviews and corrects billing edits prior to submitting claims.
3. Reviews edits to ensure proper billing and verifies edits with the appropriate Department leaders, if needed.
4. Works denials thoroughly and timely with little back-log.
5. Performs follow up on account, working with third party payers, patient, employer, and physician office to resolve unpaid or underpaid accounts. Works follow-up reports thoroughly within the month.
6. Communicates problems hindering workflow to management in a timely manner.
7. Posts copays collected at Medical Offices to vouchers.Maintains unassigned payments.
8. Processes collections accounts.
9. Processes patient and insurance refund documentation.
PHYSICAL REQUIREMENTS : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Prolonged periods of sitting.
2. Manual dexterity required to operate standard office equipment.
WORKING ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
SKILLS AND ABILITIES :
1. Excellent oral and written communication skills.
2. Basic knowledge of medical terminology.
3. General knowledge of accounts receivable and collections procedures.
