保险理赔专员 HB
Insurance Claims Specialist HB
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负责管理患者账户余额，包括准确提交索赔、遵守所有联邦/州及第三方计费法规、及时跟进以及协助处理拒付问题，以确保WVU Medicine医院的财务可行性。运用出色的客户服务、口头和书面沟通技巧，提供客户支持并解决客户咨询中出现的问题。根据需要完成报告和文书工作，支持部门的工作。与领导和其他团队成员合作，实现一流的收入周期运营。
最低资格要求：
教育、认证和/或执照：
1. 高中毕业或同等学历。
优先资格要求：
经验：
1. 一年医疗计费/医疗办公室工作经验。
核心职责和责任：此处描述的陈述旨在描述分配到此职位的人员所执行工作的总体性质。它们不打算作为所有职责和职责的详尽列表。可能会分配其他职责。
1. 向第三方保险公司准确及时地提交索赔。
2. 在提交索赔前解决索赔编辑和账户错误。
3. 遵守与第三方保险公司跟进的适当程序和时间表，以确保收款并超越部门目标。
4. 收集统计数据，完成报告并按计划或要求执行其他任务。
5. 按适当优先级组织和执行日常任务，以实现最佳生产力、问责制和效率。
6. 遵守隐私实践通知，并遵循与PHI及索赔提交/跟进相关的所有HIPAA法规。
7. 联系第三方保险公司以解决未付款项。
8. 使用保险公司门户和网站验证索赔状态并进行账户跟进。
9. 协助患者接待和护理管理进行拒付调查和解决。
10. 参加教育项目，满足与工作和个人成长相关的要求和识别的需求。
11. 按需参加部门会议、电话会议和网络广播。
12. 进行研究和处理医保材料
查看英文原文
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.
Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, 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 provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations.MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School diploma or equivalent.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. One (1) year medical billing/medical office 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. Submits accurate and timely claims to third party payers.
2. Resolves claim edits and account errors prior to claim submission.
3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals.
4. Gathers statistics, completes reports and performs other duties as scheduled or requested.
5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up.
7. Contacts third party payers to resolve unpaid claims.
8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up.
9. Assists Patient Access and Care Management with denials investigation and resolution.
10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
11. Attends department meetings, teleconferences and webcasts as necessary.
12. Researches and processes mail returns and claims rejected by the payer.
13. Reconciles billing account transactions to ensure accurate account information according to established procedures.
14. Processes billing and follow-up transactions in an accurate and timely manner.
15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.
16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
17. Maintains work queue volumes and productivity within established guidelines.
18. Provides excellent customer service to patients, visitors and employees.
19. Participates in performance improvement initiatives as requested.
20. Works with supervisor and manager to develop and exceed annual goals.
21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information.
22. Communicates problems hindering workflow to management in a timely manner.
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. Must be able to sit for extended periods of time.
2. Must have reading and comprehension ability.
3. Visual acuity must be within normal range.
4. Must be able to communicate effectively.
5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business 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. Office type environment.
SKILLS AND ABILITIES:
1. Excellent oral and written communication skills.
2. Working knowledge of computers.
3. Knowledge of medical terminology preferred.
4. Knowledge of business math preferred.
5. Knowledge of ICD-10 and CPT coding processes preferred.
6. Excellent customer service and telephone etiquette.
7. Ability to use tact and diplomacy in dealing with others.
8. 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.
9. Ability to understand written and oral communication.
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
SYSTEM West Virginia University Health SystemCost Center:
544 SYSTEM Patient Financial ServicesOriginally posted on Himalayas