Clinical Denials Specialist Careers at WVU Medicine - Remote | Apply Now!
WVU Medicine
Clinical Denials Specialist Careers at WVU Medicine - Remote | Apply Now!
Job Description
Clinical Denials Specialist at WVU Medicine: Remote Opportunity
Role Overview
As a Clinical Denials Specialist at WVU Medicine, you will be a crucial part of our revenue cycle team, ensuring the financial health of our hospitals by managing denied claims effectively. This remote position offers an exciting opportunity to leverage your skills in medical billing, coding, and insurance processing to investigate, appeal, and resolve claim denials. You will work closely with insurance companies, auditors, and internal departments to ensure compliance with regulations and optimize revenue cycle processes.
A Day in the Life
Your day will involve a variety of tasks focused on managing accounts receivable and resolving denied claims. Here’s a glimpse of what you can expect:
- Claim Triage and Routing: Accurately triage and route claims to appropriate work queues based on your knowledge of hospital departments, procedures, and payer appeal processes.
- Payer Follow-Up: Communicate with third-party payers to clarify payment remit issues, ensure timely processing of appeals, and escalate payer behavior issues to management.
- Appeal Management: Utilize payer portals and websites to verify appeal status, conduct account follow-up, and contact payers via telephone as needed.
- Non-Clinical Appeal Writing: Compose administrative, non-clinical appeals as directed by leadership and manage the submission process.
- Compliance: Stay updated on federal, state, and local regulations related to hospital billing compliance.
- Work Queue Management: Maintain work queue volumes and productivity within established standards and adhere to timely filing guidelines.
- Adjustment Posting: Post adjustments as directed by department SOP, ensuring accurate and timely processing based on contract pricing and payer models.
- Mail Management: Manage and distribute incoming mail, including Epic documentation, logging correspondence, and routing misdirected mail.
- Problem Communication: Communicate any workflow hindrances to management and provide suggestions for efficiency improvements.
- Customer Service: Provide excellent customer service to patients, employees, vendors, and auditors.
Why Remote with WVU Medicine?
WVU Medicine offers the flexibility of remote work, allowing you to balance your professional and personal life effectively. Working remotely means no commute, a more flexible schedule, and the ability to work from the comfort of your home while contributing to a leading healthcare system. You’ll be part of a supportive team that values collaboration and innovation.
Career Path
Starting as a Clinical Denials Specialist can open doors to various career paths within WVU Medicine. Potential advancement opportunities include:
- Senior Clinical Denials Specialist: Taking on more complex cases and providing guidance to junior team members.
- Denials Management Supervisor: Overseeing a team of denials specialists and ensuring optimal performance.
- Revenue Cycle Analyst: Analyzing revenue cycle data to identify trends, improve processes, and increase revenue capture.
- Compliance Officer: Ensuring adherence to billing regulations and implementing compliance programs.
- Revenue Cycle Manager: Managing various aspects of the revenue cycle, including billing, coding, and collections.
Salary and Benefits
The estimated salary range for a Clinical Denials Specialist at WVU Medicine is $38,000 to $55,000 per year. In addition to competitive pay, WVU Medicine offers a comprehensive benefits package, including:
- Health Insurance: Comprehensive medical, dental, and vision coverage.
- Paid Time Off: Generous PTO and vacation days.
- Retirement Plans: 401k and pension options.
- Life and Disability Insurance: Coverage for peace of mind.
- Flexible Spending Accounts: FSAs for healthcare and dependent care expenses.
- Employee Assistance Program: EAP for confidential support and resources.
- Tuition Reimbursement: Opportunities for continuing education and professional development.
- Wellness Programs: Initiatives to support employee health and well-being.
- Employee Discounts: Discounts on various products and services.
WVU Medicine Culture
WVU Medicine is committed to creating a supportive and inclusive work environment where employees can thrive. We value teamwork, innovation, and a patient-centered approach to healthcare. As a Clinical Denials Specialist, you will be part of a team that is dedicated to improving the financial health of our hospitals and ensuring that patients receive the care they need.
How to Apply
To apply for the Clinical Denials Specialist position, please click the “Apply” button at the top of this page and complete the application in full. Be sure to highlight your relevant skills and experience in medical billing, coding, and insurance processing. We look forward to receiving your application!
Frequently Asked Questions
- What qualifications are required for this position?
A high school diploma or equivalent is required, along with one year of training in medical billing, coding, insurance processing, or related experience. An associate degree and experience with EPIC medical billing are preferred.
- What are the main responsibilities of a Clinical Denials Specialist?
Responsibilities include triaging claims, following up with payers, writing appeals, maintaining compliance, posting adjustments, and providing excellent customer service.
- Is this a remote position?
Yes, this is a remote position.
- What kind of training will I receive?
You will receive training on WVU Medicine’s systems, processes, and relevant regulations to ensure you can perform your job effectively.
- What opportunities are there for career advancement?
Opportunities include advancing to Senior Clinical Denials Specialist, Denials Management Supervisor, Revenue Cycle Analyst, Compliance Officer, and Revenue Cycle Manager.
- What benefits does WVU Medicine offer?
WVU Medicine offers a comprehensive benefits package, including health insurance, paid time off, retirement plans, and more.
- What is the work environment like at WVU Medicine?
WVU Medicine fosters a supportive and inclusive work environment that values teamwork, innovation, and a patient-centered approach.
- How can I prepare for the interview?
Review your experience in medical billing, coding, and insurance processing. Be prepared to discuss your knowledge of regulations and your ability to solve problems and provide excellent customer service.
- What is the typical career progression for this role?
The typical career progression involves starting as a Clinical Denials Specialist and advancing to more senior roles based on performance and experience.
- What software and tools will I be using in this role?
You will primarily use EPIC medical billing system, payer portals and websites, and Microsoft Office applications.
Locations
- Remote, West Virginia, United States (Remote)
Salary
41,800 - 60,500 USD / yearly
Source: ai estimated
* This is an estimated range based on market data and may vary based on experience and qualifications.
Skills Required
- Medical Billingintermediate
- Codingintermediate
- Insurance Processingintermediate
- Denial Investigationintermediate
- Accounts Receivable Managementintermediate
- Claims Processingintermediate
- Third-Party Billing Regulationsintermediate
- Contract Agreementsintermediate
- Customer Serviceintermediate
- Oral Communicationintermediate
- Written Communicationintermediate
- Revenue Cycle Processesintermediate
- Appeal Writingintermediate
- Data Entryintermediate
- Payment Postingintermediate
- Microsoft Excelintermediate
- Microsoft Wordintermediate
- EPIC Medical Billing Systemintermediate
- Payer Portalsintermediate
- Payer Websitesintermediate
- Problem-solvingintermediate
- Time Managementintermediate
- Prioritizationintermediate
- Complianceintermediate
- Documentationintermediate
- Mail Managementintermediate
- Data Analysisintermediate
- Reportingintermediate
- Project Managementintermediate
Required Qualifications
- High School diploma or equivalent required. (experience)
- One (1) year of training in medical billing, coding, insurance processing, or other related experience required. (experience)
- Associate degree in related field preferred. (experience)
- Knowledge and experience with EPIC medical billing preferred. (experience)
- Experience with Microsoft Excel/Word preferred. (experience)
- Experience with hospital billing preferred. (experience)
- Understanding of hospital/clinic departments, procedures, and payer appeal processes. (experience)
- Familiarity with federal, state, and local regulations pertaining to hospital billing compliance. (experience)
- Ability to follow established standards and timely filing guidelines. (experience)
- Excellent customer service skills. (experience)
- Ability to communicate effectively with patients, employees, vendors, and auditors. (experience)
- Proficiency in using Microsoft Office applications. (experience)
- Ability to manage and distribute incoming mail accurately and timely. (experience)
- Ability to maintain work queue volumes and productivity within established standards. (experience)
Responsibilities
- Accurately triage and route claims to work queues.
- Follow up with third party payers to clarify payment remit issues.
- Ensure timely appeal receipt, process, and resolution.
- Adhere to appropriate procedures and timelines.
- Escalate payer behavior issues to management.
- Utilize payer portals and payer websites to verify appeal status and conduct account follow-up.
- Contact payers by telephone when needed.
- Compose administrative, non-clinical appeals as directed by leadership.
- Organize and manage appeal letter submissions via mail or other portals.
- Develop and maintain working knowledge of all federal, state, and local regulations pertaining to hospital billing compliance regulations.
- Maintain work queue volumes and productivity within established standards.
- Adhere to timely filing guidelines for work queue prioritization.
- Post adjustments as directed or by following department SOP.
- Ensure accurate and timely processing, and validating based on contract pricing/payer models.
- Manage and distribute incoming mail in an accurate and timely manner.
- Include Epic documentation, logging incoming correspondence, uploading to document warehouse and routing mis-directed mail.
- Process outgoing certified mail.
- Communicate problems hindering workflow to management in a timely manner.
- Provide suggestions to increase workflow efficiency.
- Participate in educational programs to meet mandatory requirements and identified needs regarding job and personal growth.
- Attend department meetings, teleconferences, and webinars as necessary or directed.
- Provide excellent customer service to patients, employees, vendors, and auditors.
- Utilize Microsoft Office or other applications as needed to complete job functions, specific reporting, or project management.
Benefits
- general: Comprehensive health insurance (medical, dental, vision)
- general: Paid time off (PTO) and vacation days
- general: Retirement plan options (401k, pension)
- general: Life insurance
- general: Disability insurance (short-term and long-term)
- general: Flexible spending accounts (FSA)
- general: Health savings accounts (HSA)
- general: Employee assistance program (EAP)
- general: Tuition reimbursement
- general: Professional development opportunities
- general: Wellness programs
- general: Employee discounts
- general: Relocation assistance (if applicable)
- general: Sign-on bonus (if applicable)
- general: Paid holidays
- general: Parental leave
- general: Adoption assistance
- general: Employee referral program
- general: On-site childcare (if applicable)
- general: Gym membership discounts
Tags & Categories
Answer 10 quick questions to check your fit for Clinical Denials Specialist Careers at WVU Medicine - Remote | Apply Now! @ WVU Medicine.
Related Books and Jobs
Clinical Denials Specialist Careers at WVU Medicine - Remote | Apply Now!
WVU Medicine
Clinical Denials Specialist Careers at WVU Medicine - Remote | Apply Now!
Job Description
Clinical Denials Specialist at WVU Medicine: Remote Opportunity
Role Overview
As a Clinical Denials Specialist at WVU Medicine, you will be a crucial part of our revenue cycle team, ensuring the financial health of our hospitals by managing denied claims effectively. This remote position offers an exciting opportunity to leverage your skills in medical billing, coding, and insurance processing to investigate, appeal, and resolve claim denials. You will work closely with insurance companies, auditors, and internal departments to ensure compliance with regulations and optimize revenue cycle processes.
A Day in the Life
Your day will involve a variety of tasks focused on managing accounts receivable and resolving denied claims. Here’s a glimpse of what you can expect:
- Claim Triage and Routing: Accurately triage and route claims to appropriate work queues based on your knowledge of hospital departments, procedures, and payer appeal processes.
- Payer Follow-Up: Communicate with third-party payers to clarify payment remit issues, ensure timely processing of appeals, and escalate payer behavior issues to management.
- Appeal Management: Utilize payer portals and websites to verify appeal status, conduct account follow-up, and contact payers via telephone as needed.
- Non-Clinical Appeal Writing: Compose administrative, non-clinical appeals as directed by leadership and manage the submission process.
- Compliance: Stay updated on federal, state, and local regulations related to hospital billing compliance.
- Work Queue Management: Maintain work queue volumes and productivity within established standards and adhere to timely filing guidelines.
- Adjustment Posting: Post adjustments as directed by department SOP, ensuring accurate and timely processing based on contract pricing and payer models.
- Mail Management: Manage and distribute incoming mail, including Epic documentation, logging correspondence, and routing misdirected mail.
- Problem Communication: Communicate any workflow hindrances to management and provide suggestions for efficiency improvements.
- Customer Service: Provide excellent customer service to patients, employees, vendors, and auditors.
Why Remote with WVU Medicine?
WVU Medicine offers the flexibility of remote work, allowing you to balance your professional and personal life effectively. Working remotely means no commute, a more flexible schedule, and the ability to work from the comfort of your home while contributing to a leading healthcare system. You’ll be part of a supportive team that values collaboration and innovation.
Career Path
Starting as a Clinical Denials Specialist can open doors to various career paths within WVU Medicine. Potential advancement opportunities include:
- Senior Clinical Denials Specialist: Taking on more complex cases and providing guidance to junior team members.
- Denials Management Supervisor: Overseeing a team of denials specialists and ensuring optimal performance.
- Revenue Cycle Analyst: Analyzing revenue cycle data to identify trends, improve processes, and increase revenue capture.
- Compliance Officer: Ensuring adherence to billing regulations and implementing compliance programs.
- Revenue Cycle Manager: Managing various aspects of the revenue cycle, including billing, coding, and collections.
Salary and Benefits
The estimated salary range for a Clinical Denials Specialist at WVU Medicine is $38,000 to $55,000 per year. In addition to competitive pay, WVU Medicine offers a comprehensive benefits package, including:
- Health Insurance: Comprehensive medical, dental, and vision coverage.
- Paid Time Off: Generous PTO and vacation days.
- Retirement Plans: 401k and pension options.
- Life and Disability Insurance: Coverage for peace of mind.
- Flexible Spending Accounts: FSAs for healthcare and dependent care expenses.
- Employee Assistance Program: EAP for confidential support and resources.
- Tuition Reimbursement: Opportunities for continuing education and professional development.
- Wellness Programs: Initiatives to support employee health and well-being.
- Employee Discounts: Discounts on various products and services.
WVU Medicine Culture
WVU Medicine is committed to creating a supportive and inclusive work environment where employees can thrive. We value teamwork, innovation, and a patient-centered approach to healthcare. As a Clinical Denials Specialist, you will be part of a team that is dedicated to improving the financial health of our hospitals and ensuring that patients receive the care they need.
How to Apply
To apply for the Clinical Denials Specialist position, please click the “Apply” button at the top of this page and complete the application in full. Be sure to highlight your relevant skills and experience in medical billing, coding, and insurance processing. We look forward to receiving your application!
Frequently Asked Questions
- What qualifications are required for this position?
A high school diploma or equivalent is required, along with one year of training in medical billing, coding, insurance processing, or related experience. An associate degree and experience with EPIC medical billing are preferred.
- What are the main responsibilities of a Clinical Denials Specialist?
Responsibilities include triaging claims, following up with payers, writing appeals, maintaining compliance, posting adjustments, and providing excellent customer service.
- Is this a remote position?
Yes, this is a remote position.
- What kind of training will I receive?
You will receive training on WVU Medicine’s systems, processes, and relevant regulations to ensure you can perform your job effectively.
- What opportunities are there for career advancement?
Opportunities include advancing to Senior Clinical Denials Specialist, Denials Management Supervisor, Revenue Cycle Analyst, Compliance Officer, and Revenue Cycle Manager.
- What benefits does WVU Medicine offer?
WVU Medicine offers a comprehensive benefits package, including health insurance, paid time off, retirement plans, and more.
- What is the work environment like at WVU Medicine?
WVU Medicine fosters a supportive and inclusive work environment that values teamwork, innovation, and a patient-centered approach.
- How can I prepare for the interview?
Review your experience in medical billing, coding, and insurance processing. Be prepared to discuss your knowledge of regulations and your ability to solve problems and provide excellent customer service.
- What is the typical career progression for this role?
The typical career progression involves starting as a Clinical Denials Specialist and advancing to more senior roles based on performance and experience.
- What software and tools will I be using in this role?
You will primarily use EPIC medical billing system, payer portals and websites, and Microsoft Office applications.
Locations
- Remote, West Virginia, United States (Remote)
Salary
41,800 - 60,500 USD / yearly
Source: ai estimated
* This is an estimated range based on market data and may vary based on experience and qualifications.
Skills Required
- Medical Billingintermediate
- Codingintermediate
- Insurance Processingintermediate
- Denial Investigationintermediate
- Accounts Receivable Managementintermediate
- Claims Processingintermediate
- Third-Party Billing Regulationsintermediate
- Contract Agreementsintermediate
- Customer Serviceintermediate
- Oral Communicationintermediate
- Written Communicationintermediate
- Revenue Cycle Processesintermediate
- Appeal Writingintermediate
- Data Entryintermediate
- Payment Postingintermediate
- Microsoft Excelintermediate
- Microsoft Wordintermediate
- EPIC Medical Billing Systemintermediate
- Payer Portalsintermediate
- Payer Websitesintermediate
- Problem-solvingintermediate
- Time Managementintermediate
- Prioritizationintermediate
- Complianceintermediate
- Documentationintermediate
- Mail Managementintermediate
- Data Analysisintermediate
- Reportingintermediate
- Project Managementintermediate
Required Qualifications
- High School diploma or equivalent required. (experience)
- One (1) year of training in medical billing, coding, insurance processing, or other related experience required. (experience)
- Associate degree in related field preferred. (experience)
- Knowledge and experience with EPIC medical billing preferred. (experience)
- Experience with Microsoft Excel/Word preferred. (experience)
- Experience with hospital billing preferred. (experience)
- Understanding of hospital/clinic departments, procedures, and payer appeal processes. (experience)
- Familiarity with federal, state, and local regulations pertaining to hospital billing compliance. (experience)
- Ability to follow established standards and timely filing guidelines. (experience)
- Excellent customer service skills. (experience)
- Ability to communicate effectively with patients, employees, vendors, and auditors. (experience)
- Proficiency in using Microsoft Office applications. (experience)
- Ability to manage and distribute incoming mail accurately and timely. (experience)
- Ability to maintain work queue volumes and productivity within established standards. (experience)
Responsibilities
- Accurately triage and route claims to work queues.
- Follow up with third party payers to clarify payment remit issues.
- Ensure timely appeal receipt, process, and resolution.
- Adhere to appropriate procedures and timelines.
- Escalate payer behavior issues to management.
- Utilize payer portals and payer websites to verify appeal status and conduct account follow-up.
- Contact payers by telephone when needed.
- Compose administrative, non-clinical appeals as directed by leadership.
- Organize and manage appeal letter submissions via mail or other portals.
- Develop and maintain working knowledge of all federal, state, and local regulations pertaining to hospital billing compliance regulations.
- Maintain work queue volumes and productivity within established standards.
- Adhere to timely filing guidelines for work queue prioritization.
- Post adjustments as directed or by following department SOP.
- Ensure accurate and timely processing, and validating based on contract pricing/payer models.
- Manage and distribute incoming mail in an accurate and timely manner.
- Include Epic documentation, logging incoming correspondence, uploading to document warehouse and routing mis-directed mail.
- Process outgoing certified mail.
- Communicate problems hindering workflow to management in a timely manner.
- Provide suggestions to increase workflow efficiency.
- Participate in educational programs to meet mandatory requirements and identified needs regarding job and personal growth.
- Attend department meetings, teleconferences, and webinars as necessary or directed.
- Provide excellent customer service to patients, employees, vendors, and auditors.
- Utilize Microsoft Office or other applications as needed to complete job functions, specific reporting, or project management.
Benefits
- general: Comprehensive health insurance (medical, dental, vision)
- general: Paid time off (PTO) and vacation days
- general: Retirement plan options (401k, pension)
- general: Life insurance
- general: Disability insurance (short-term and long-term)
- general: Flexible spending accounts (FSA)
- general: Health savings accounts (HSA)
- general: Employee assistance program (EAP)
- general: Tuition reimbursement
- general: Professional development opportunities
- general: Wellness programs
- general: Employee discounts
- general: Relocation assistance (if applicable)
- general: Sign-on bonus (if applicable)
- general: Paid holidays
- general: Parental leave
- general: Adoption assistance
- general: Employee referral program
- general: On-site childcare (if applicable)
- general: Gym membership discounts
Tags & Categories
Answer 10 quick questions to check your fit for Clinical Denials Specialist Careers at WVU Medicine - Remote | Apply Now! @ WVU Medicine.
Related Books and Jobs