Lead Insurance Claims Specialist HB

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Responsible for managing patient account balances including accurate claim submission, compliance with federal and state regulations and third‑party billing, 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 provideใช support and resolve issues from customer inquiries. Researches and resolves co‑worker process questions and concerns.

Supports the department with reports and clerical duties and works with leadership and team members to optimize revenue cycle operations.

• High School Graduate kindlasti equivalent.
• HFMA Certified Revenue Cycle Representative (CRCR) Certification within 90 days of hire.
• Completes sixteen hours of revenue cycle continuing education required annually.

• Six (6) years medical billing/medical office experience, including nine (9) months directly working with hospital insurance claims.

• Six (6) years medical billing/medical office experience, preferably related to claims billing and insurance follow‑up.

• Submits accurate and timely claims to third‑party payers.
• Resolves claim edits and account errors prior to claim submission.
• Adheres to appropriate procedures and timelines for follow‑up with third‑party payers to ensure collections and to exceed department goals.
• Gathers statistics, completes reports and performs other duties as scheduled or requested.
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
• Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow‑up.
• Contacts third‑party payers to resolve unpaid claims.
• Utilizes payer portals and payer websites to verify claim status and conduct account follow‑up.
• Assists Patient Access and Care Management with denials investigation and resolution.
• Accesses and utilizes all necessary computer software, applications and equipment to perform job role.
• Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
• Attends department meetings, teleconferences and webcasts as necessary.
• Researches and processes mail returns and claims rejected by the payer.
• Reconciles billing account transactions to ensure accurate account information according to established procedures.
• Processes billing and follow‑up transactions in an accurate and timely manner.
• Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.
• Mon材料ates accounts to facilitate timely follow‑up and payment to maximize cash receipts.
• Maintains work queue volumes and productivity within established guidelines.
• Provides excellent customer service to patients, visitors and employees.
• Participates in performance improvement initiatives as requested.
• Works with supervisor and manager to develop and exceed annual goals.
• Maintains confidentiality according to policy when interacting with patients, physicians, families, co‑workers and the public regarding demographic/clinical/financial information.
• Communicates problems hindering workflow to management in a timely manner.
• Researches and resolves staff questions and concerns. Summarizes for supervisors/managers and works with leadership to resolve/improve workflows.
• Works with HB Trainer to identify training opportunities for staff.
• ستېworks with Revenue Cycle Systems Coordinators to optimize Quadax and other PFS specific applications for end users.
• Works with managers/supervisors and Contracting to prepare for payer meetings and calls by summarizing issues and collecting staff concerns.
• Represents end users for vendor demonstrations, training sessions, payer workshops and educational sessions and communicates information back to staff.
• Exceeds productivity measures in like work group as demonstrated by Epic dashboards.
• Leads special projects and/or other work assignments as…