Insurance Claims Specialist

Overview

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• 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.
• Performs claims processing to third party payer according to payer guidelines.
• Reviews and corrects billing edits prior to submitting claims.
• Reviews edits to ensure proper billing and verifies edits with the appropriate Department leaders, if needed.
• Works denials thoroughly and timely with little back-log.
• 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.
• Communicates problems hindering workflow to management in a timely manner.
• Posts copays collected at Medical Offices to vouchers. Maintains unassigned payments.
• Processes collections accounts.
• Processes patient and insurance refund documentation.

Education, Certification, and/or Licensure: High school diploma or equivalent. State criminal background check and Federal (if applicable), as required for regulated areas.

Experience

Preferred Qualifications:

• Previous hospital billing and/or credit and collection experience.

• Prolonged periods of sitting.
• Manual dexterity required to operate standard office equipment.

• Standard office environment.

• Excellent oral and written communication skills.
• Basic knowledge of medical terminology.
• General knowledge of accounts receivable and collections procedures.

• Scheduled Weekly
  
  Hours:
  
  20
• Exempt/Non-Exempt
• Shift: United States of America (Non-Exempt)

CCMC Camden Clark Medical Center

500 CCMC Administration

800 Grand Central Mall, Vienna, West Virginia

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law.

All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment.