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WVU Medicine · 3 months ago

Insurance Accounting Specialist - Peak Health

Peak Health Administrative Building

Full-time

Hybrid

Entry Level

2+ years exp

WVU Medicine is seeking an Insurance Accounting Specialist to join their team. This role involves providing financial, administrative, and clerical support within the Accounting/Finance department, including processing vendor invoices and managing claims funding and settlement analytics.

Health CareHospitalMedical

Responsibilities

Premium Billing - processes the monthly premium billing cycle for ASO PEPM fees and Medicare Advantage enrollees. Reconciles invoices and premium receipt reports to premium billing reports. Reconciles and applies payments received for premium invoices

CRM Responsibilities - Research, resolve and communicate resolution to internal team as well as external vendors for any finance related customer relationship management (CRM) request(s)

Claims Funding - Communicates weekly claims funding totals for both capitated and non-capitated claims to ASO clients as part of the weekly claims settlement process

Claims Settlement Analytics - Provides management with weekly claims settlement analytics and reports

Manages vendor information for accuracy relating to address and banking information to ensure payments to vendors are received and/or processed in a timely fashion

Compiles and processes accounts payable, maintains day to day payment cycle, and provides efficient customer service. Ensure all Medicare Advantage claims are settled and processed in a timely manner to avoid penalty

Verify approval on all vendor payment requests

Process payments to contracted providers for claims submitted to and processed by the Claims Operations department

Resolves problems associated with vendor payables transactions

Reconciles processed work by verifying entries and comparing system reports to balances

Provides accurate and effective document preparation and records management relative to the Claims Payable function in accordance with records retention policies and procedures, and any federal regulations

Maintain relationships will all areas of the organization to ensure effective, efficient, and accurate workflow processes as it relates to claims processing and customer service to both internal and external clients

Protects organization’s value by keeping information confidential. Adere to all HIPPA regulations

Updates job knowledge by participating in educational opportunities

Maintains historical records by imaging and filing documents