Insurance Claims Specialist

WVU Medicine

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

Posted 9/29/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical billing processes, including claim submission, denial management, and compliance with HIPAA regulations. Proficient in customer service and communication, with a strong understanding of revenue cycle operations and medical terminology.

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 AdjudicationPayer RelationsContractual Claims ProcessingCredit Balance ResolutionStatistical Reporting

Soft Skills

Excellent Communication SkillsTact and DiplomacyOrganizational SkillsProblem-Solving SkillsCustomer Service Etiquette

Tools & Technologies

Payer PortalsBilling SoftwareOffice Equipment

Industry Keywords

HIPAA ComplianceThird-Party ReimbursementHealthcare RegulationsPatient Account Management

About the role

Key responsibilities & impact

Manage patient account balances, including accurate claim submission, regulatory compliance, timely follow-up, and denial management
Provide customer support and resolve issues arising from customer inquiries
Complete reports and clerical duties as needed
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 support collections and department goals
Gather statistics and complete reports
Organize and prioritize daily tasks to optimize productivity, accountability, and efficiency
Follow HIPAA regulations and Notices of Privacy Practices regarding PHI and claim submission/follow-up
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
Attend educational programs, department meetings, teleconferences, and webcasts as necessary
Research and process mail returns and payer-rejected claims
Reconcile billing account transactions and process billing/follow-up transactions accurately and timely
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
Participate in performance improvement initiatives
Work with supervisor and manager 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

Participation in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions