Insurance Claims Specialist

WVU Medicine

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

Posted 11/2/2026full-timeUnited StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing patient account balances, including claim submission, regulatory compliance, and denial management. Proficient in customer service, communication, and maintaining confidentiality of sensitive information.

Highest-signal resume keywords

Claim SubmissionRegulatory ComplianceCustomer ServiceICD-10 CodingRevenue Cycle Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim SubmissionICD-10 CodingCPT CodingBusiness MathRevenue Cycle OperationsClaims AdjudicationContractual Claims ProcessingCredit Balance ResolutionPayer RelationsStatistical Reporting

Soft Skills

Excellent Communication SkillsTact and DiplomacyCustomer Service EtiquetteProblem-SolvingOrganizational Skills

Tools & Technologies

Payer PortalsBilling SoftwareBusiness Equipment

Industry Keywords

HIPAA RegulationsPatient Account ManagementThird-Party ReimbursementMedical TerminologyPerformance Improvement Initiatives

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 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 for productivity, accountability and efficiency
Comply with Notices of Privacy Practices and HIPAA regulations concerning 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
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 maximize cash receipts
Maintain work queue volumes and productivity within established guidelines
Provide customer service to patients, visitors and employees
Participate in performance improvement initiatives
Work with supervisors and managers to develop and exceed annual goals
Maintain confidentiality of demographic, clinical and financial information
Communicate workflow problems to management

Requirements

What you’ll need

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
Ability to understand written and oral communication
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, medical terminology, payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures
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