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WVU Medicine · 7 hours ago

Insurance Claim Specialist

Core, WV

Full-time

Onsite

Entry Level

1+ years exp

WVU Medicine is a healthcare organization, and they are seeking an Insurance Claim Specialist to manage patient account balances and ensure accurate claim submissions. The role involves customer service, compliance with billing regulations, and support for denial management to maintain financial viability.

Health CareHospitalMedical

H1B Sponsor Likely

Responsibilities

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

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 professional billing

Monitors 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

Qualification

Medical billing experienceICD-10CPT codingCustomer service skillsMedical terminologyCommunication skillsBusiness math knowledgeWorking knowledge of computersTactDiplomacy

Required

High School diploma or equivalent

Excellent oral and written communication skills

Working knowledge of computers

Excellent customer service and telephone etiquette

Ability to use tact and diplomacy in dealing with others

Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures

Ability to understand written and oral communication

Must be able to sit for extended periods of time

Must have reading and comprehension ability

Visual acuity must be within normal range

Must be able to communicate effectively

Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment

Preferred

One (1) year medical billing/medical office experience

Knowledge of medical terminology preferred

Knowledge of business math preferred

Knowledge of ICD-10 and CPT coding processes preferred

Company

WVU Medicine

Glassdoor3.6

West Virginia University Health System is a non-profit organization that offers a full range of healthcare services.

Founded in 1898

Morgantown, West Virginia, USA

10001+ employees

https://wvumedicine.org/

H1B Sponsorship

WVU Medicine has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (9)

2024 (11)

2023 (9)

2022 (9)

2021 (7)

2020 (6)