Insurance Claims Specialist

WVU Medicine

. Manage patient account balances, including accurate claim submission, regulatory compliance, timely follow-up, and denial management assistance .

Posted 11/5/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical billing processes, including claim submission, denial management, and revenue cycle operations. Proficient in maintaining compliance with federal, state, and local regulations while providing exceptional customer service.

Highest-signal resume keywords

Medical Billing ExperienceICD-10 Coding KnowledgeCPT Coding KnowledgeRevenue Cycle OperationsCustomer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim SubmissionDenial ManagementBilling ReconciliationBusiness MathMedical TerminologyClaims AdjudicationContractual Claims ProcessingCredit Balance ResolutionPayer RelationsThird Party Reimbursement

Soft Skills

Excellent Communication SkillsTact and DiplomacyCustomer Service EtiquetteProblem-Solving SkillsAbility to Work in a Team

Tools & Technologies

Payer PortalsBilling SoftwareComputersFax MachinesTelephones

Industry Keywords

Regulatory ComplianceClaim EditsAccount Follow-UpPerformance ImprovementConfidentiality

About the role

Key responsibilities & impact

Manage patient account balances, including accurate claim submission, regulatory compliance, timely follow-up, and denial management assistance
Provide customer support and resolve issues arising from customer inquiries
Submit accurate and timely claims to third-party payers
Resolve claim edits and account errors before claim submission
Follow up with third-party payers to ensure collections and exceed department goals
Gather statistics, complete reports, and perform clerical duties
Contact third-party payers to resolve unpaid claims
Use payer portals and websites to verify claim status and conduct account follow-up
Assist Patient Access and Care Management with denial investigation and resolution
Research and process mail returns and payer-rejected claims
Reconcile billing account transactions and process billing and follow-up transactions
Maintain knowledge of federal, state, and local hospital billing regulations
Monitor accounts to facilitate timely follow-up and payment and maximize cash receipts
Maintain work queue volumes and productivity within established guidelines
Provide excellent customer service to patients, visitors, and employees
Attend department meetings, teleconferences, and webcasts as necessary
Participate in performance improvement initiatives
Work with supervisors and managers to develop and exceed annual goals
Maintain confidentiality regarding demographic, clinical, and financial information
Communicate workflow problems to management in a timely manner

Requirements

What you’ll need

High School diploma or equivalent
One (1) year medical billing/medical office experience preferred
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
Knowledge of medical terminology preferred
Knowledge of business math preferred
Knowledge of ICD-10 and CPT coding processes preferred
Knowledge of revenue cycle operations, third party reimbursement, 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

Benefits

Comp & perks

Full-time schedule of 40 hours per week
Participation in educational programs for mandatory requirements, job growth, and personal growth
Reasonable accommodations may be made for individuals with disabilities