Insurance Claims Specialist (87952) - ACQUISITION

📌 Core Information

🔹 Job Title: Insurance Claims Specialist (87952) - ACQUISITION

🔹 Company: WVU Medicine

🔹 Location: Remote (Home Work - Monongalia County WV (Local))

🔹 Job Type: Full-Time

🔹 Category: Healthcare

🔹 Date Posted: May 27, 2025

🔹 Experience Level: Entry-Level (0-2 years)

🔹 Remote Status: Hybrid (Remote with local presence)

🚀 Job Overview

Key aspects of this role include:

• Managing patient account balances and accurate claim submission
• Compliance with federal, state, and third-party billing regulations
• Timely follow-up and denial management to ensure financial viability
• Excellent customer service and communication skills to resolve issues

ASSUMPTION: This role requires strong organizational skills and attention to detail, as well as the ability to work independently and manage multiple tasks.

📋 Key Responsibilities

✅ Submit accurate and timely claims to third-party payers

✅ Resolve claim edits and account errors prior to claim submission

✅ Adhere to appropriate procedures and timelines for follow-up with third-party payers

✅ Gather statistics, complete reports, and perform other duties as scheduled or requested

✅ Organize and execute daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency

✅ Comply with Notices of Privacy Practices and follow all HIPAA regulations pertaining to PHI and claim submission/follow-up

✅ Contact third-party payers to resolve unpaid claims

✅ Utilize payer portals and payer websites to verify claim status and conduct account follow-up

✅ Assist Patient Access and Care Management with denials investigation and resolution

✅ Participate in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth

✅ Attend department meetings, teleconferences, and webcasts as necessary

✅ Research and process mail returns and claims rejected by the payer

✅ Reconcile billing account transactions to ensure accurate account information according to established procedures

✅ Process billing and follow-up transactions in an accurate and timely manner

✅ Develop and maintain working knowledge of all federal, state, and local regulations pertaining to professional billing

✅ Monitor accounts to facilitate timely follow-up and payment to 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 as requested

✅ Work with supervisor and manager to develop and exceed annual goals

✅ Maintain confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information

✅ Communicate problems hindering workflow to management in a timely manner

ASSUMPTION: This role requires strong problem-solving skills and the ability to work in a fast-paced environment with competing priorities.

🎯 Required Qualifications

Education: High School diploma or equivalent

Experience: None specified

Required Skills:

• Excellent oral and written communication skills
• Working knowledge of computers
• Knowledge of medical terminology preferred
• Knowledge of business math preferred
• Knowledge of ICD-10 and CPT coding processes preferred
• Excellent customer service and telephone etiquette
• Ability to use tact and diplomacy in dealing with others
• Ability to understand written and oral communication

Preferred Skills:

• One (1) year of medical billing/medical office experience

ASSUMPTION: While not explicitly stated, having some experience in medical billing or a related field would be beneficial for this role.

💰 Compensation & Benefits

Salary Range: $30,000 - $40,000 per year (Estimated based on industry standards for entry-level medical billing positions in West Virginia)

Benefits:

• Health, dental, and vision insurance
• Retirement savings plan with employer match
• Paid time off (vacation, sick, and holidays)
• Tuition reimbursement and professional development opportunities
• Employee assistance program

Working Hours: 40 hours per week, with flexible scheduling options available

ASSUMPTION: The salary range provided is an estimate based on industry standards and may vary depending on the candidate's qualifications and experience.

📌 Applicant Insights

🔍 Company Context

Industry: WVU Medicine is a nonprofit healthcare system that operates under the brand WVU Medicine. It is West Virginia’s largest health system and the state’s largest employer, with more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.

Company Size: 10,001+ employees

Founded: The West Virginia University Health System was established in 1996, with WVU Medicine operating under the brand since 2014.

Company Description:

• WVU Medicine is a comprehensive healthcare system that provides a wide range of services, including neurosurgery, pediatrics, emergency medicine, cardiothoracic surgery, cancer services, sports medicine, internal medicine, orthopaedics, and heart and vascular care.
• The Health System is comprised of 25 hospitals, including J.W. Ruby Memorial Hospital, an 880-bed academic medical center, and the 150-bed WVU Medicine Children’s Hospital in Morgantown, West Virginia.
• WVU Medicine is committed to providing high-quality, patient-centered care and is dedicated to improving the health of the communities it serves.

Company Specialties:

• Neurosurgery
• Pediatrics
• Emergency medicine
• Cardiothoracic surgery
• Cancer services
• Sports medicine
• Internal medicine
• Orthopaedics
• Heart and vascular care

Company Website: WVUMedicine.org

ASSUMPTION: WVU Medicine's large size and comprehensive range of services provide ample opportunities for career growth and development within the organization.

📊 Role Analysis

Career Level: Entry-level to mid-level, with opportunities for growth and advancement within the revenue cycle operations department

Reporting Structure: This role reports directly to the supervisor of the Patient Financial Services department

Work Arrangement: Hybrid (Remote with local presence required for on-site meetings and training)

Growth Opportunities:

• Advancement within the revenue cycle operations department, such as becoming a team lead or supervisor
• Transition to other roles within the healthcare system, such as patient access or care management
• Professional development opportunities, such as tuition reimbursement and training programs

ASSUMPTION: This role offers opportunities for career growth and development within the revenue cycle operations department and the broader healthcare system.

🌍 Location & Work Environment

Office Type: Hybrid (Remote with local presence required)

Office Location(s): Morgantown, WV (with remote work options)

Geographic Context:

• Morgantown is a city in Monongalia County, West Virginia, with a population of approximately 30,000 people
• The city is home to West Virginia University and has a vibrant downtown area with numerous restaurants, shops, and cultural attractions
• Morgantown is located in the northern panhandle of West Virginia, approximately 70 miles south of Pittsburgh, Pennsylvania

Work Schedule: Monday-Friday, 8:00 AM - 5:00 PM (with flexible scheduling options available)

ASSUMPTION: The hybrid work arrangement allows for a balance between remote work and on-site collaboration, providing flexibility while maintaining a connection to the office and team.

💼 Interview & Application Insights

Typical Process:

• Online application submission
• Phone or video screen with the hiring manager
• In-person or virtual interview with the hiring manager and team members
• Background check and reference check
• Job offer and onboarding

Key Assessment Areas:

• Communication skills and customer service orientation
• Problem-solving abilities and attention to detail
• Knowledge of medical terminology and billing processes
• Ability to work independently and manage multiple tasks

Application Tips:

• Highlight relevant experience and skills in your resume, focusing on medical billing, customer service, and communication
• Tailor your cover letter to the specific role and company, emphasizing your fit for the position and enthusiasm for the opportunity
• Prepare examples of your problem-solving skills and ability to handle multiple tasks in a fast-paced environment

ATS Keywords: Medical billing, claim submission, customer service, communication skills, problem-solving, attention to detail, revenue cycle operations, HIPAA compliance, ICD-10 coding, CPT coding

ASSUMPTION: The interview process for this role will focus on assessing the candidate's communication skills, problem-solving abilities, and fit with the company culture and team dynamics.

🛠️ Tools & Technologies

• Medical billing software (e.g., Epic, Cerner, or other EHR systems)
• Microsoft Office Suite (Word, Excel, PowerPoint)
• Customer relationship management (CRM) software (e.g., Salesforce, Microsoft Dynamics, or other CRM systems)
• Payer portals and websites (e.g., Medicare, Medicaid, Blue Cross Blue Shield, Aetna, etc.)

ASSUMPTION: The specific tools and technologies used in this role may vary depending on the department and the healthcare system's preferred vendors and systems.

👔 Cultural Fit Considerations

Company Values:

• Patient-centered care
• Collaboration and teamwork
• Excellence and continuous improvement
• Integrity and accountability
• Respect and compassion

Work Style:

• Fast-paced and dynamic environment
• Strong focus on customer service and patient satisfaction
• Opportunities for professional development and growth
• Collaborative and supportive team culture

Self-Assessment Questions:

• Do you have strong communication skills and the ability to handle difficult customer inquiries with professionalism and empathy?
• Are you detail-oriented and able to manage multiple tasks in a fast-paced environment?
• Do you have a strong commitment to patient-centered care and continuous improvement?

ASSUMPTION: WVU Medicine values candidates who are passionate about patient care, committed to excellence, and able to work collaboratively in a dynamic and fast-paced environment.

⚠️ Potential Challenges

• Handling difficult customer inquiries and resolving billing issues
• Meeting department goals and maintaining productivity in a fast-paced environment
• Adapting to changes in regulations and billing processes
• Balancing remote work and on-site collaboration in a hybrid work arrangement

ASSUMPTION: These challenges can be overcome with strong communication skills, attention to detail, and a commitment to continuous learning and improvement.

📈 Similar Roles Comparison

• This role is similar to other medical billing positions, but may have a stronger focus on customer service and follow-up due to the hybrid work arrangement
• Compared to other healthcare roles, this position requires strong communication skills and attention to detail, but may have less direct patient contact
• Career progression in this role may involve advancing within the revenue cycle operations department or transitioning to other roles within the healthcare system

ASSUMPTION: This role offers a unique blend of medical billing and customer service responsibilities, with opportunities for growth and development within the revenue cycle operations department and the broader healthcare system.

📝 Sample Projects

• Developing and implementing a new process for resolving unpaid claims
• Creating and delivering training sessions on ICD-10 coding and billing processes for new hires
• Analyzing and improving the efficiency of the claim submission and follow-up process

ASSUMPTION: These sample projects demonstrate the candidate's ability to analyze and improve processes, as well as their commitment to continuous learning and improvement.

❓ Key Questions to Ask During Interview

• What are the most challenging aspects of this role, and how can I best prepare to succeed in them?
• How does this role fit into the broader revenue cycle operations department and the healthcare system as a whole?
• What opportunities are there for professional development and growth within the department and the healthcare system?
• How does the hybrid work arrangement balance remote work and on-site collaboration, and what tools and technologies are used to facilitate this?
• What are the most important qualities and skills for success in this role, and how do they align with my own strengths and areas for improvement?

ASSUMPTION: Asking thoughtful and insightful questions demonstrates the candidate's interest in the role and their commitment to success.

📌 Next Steps for Applicants

To apply for this position:

• Submit your application through the WVU Medicine careers website
• Tailor your resume to highlight relevant experience and skills, focusing on medical billing, customer service, and communication
• Write a cover letter that emphasizes your fit for the position and enthusiasm for the opportunity
• Prepare examples of your problem-solving skills and ability to handle multiple tasks in a fast-paced environment
• Follow up with the hiring manager one week after submitting your application to express your continued interest in the position

⚠️ This job description contains AI-assisted information. Details should be verified directly with the employer before making decisions.