Clinical Denials Specialist at WVU Medicine: Remote Opportunity

Role Overview

As a Clinical Denials Specialist at WVU Medicine, you will play a critical role in ensuring the financial health of our hospitals by managing accounts receivable related to denied claims. This position requires a detail-oriented individual with a strong understanding of medical billing, coding, and insurance processing. You will be responsible for investigating denials, following up with insurance companies, and writing non-clinical appeals to recover revenue. Your expertise will contribute to the efficiency and effectiveness of our revenue cycle processes.

A Day in the Life

Here’s a glimpse into what your daily routine might look like:

1. Claim Triage: Start your day by accurately triaging and routing claims to the appropriate work queues based on hospital/clinic departments, procedures, and payer appeal processes.
2. Payer Follow-Up: Contact third-party payers to clarify payment remit issues and ensure timely appeal processing. Utilize payer portals and websites to verify appeal status.
3. Appeal Writing: Compose administrative, non-clinical appeals as directed by leadership, organizing and managing appeal letter submissions.
4. Regulatory Compliance: Stay updated on federal, state, and local regulations pertaining to hospital billing compliance, ensuring all activities align with these guidelines.
5. Work Queue Management: Maintain work queue volumes and productivity within established standards, adhering to timely filing guidelines.
6. Adjustment Posting: Post adjustments as directed or by following department SOP, ensuring accurate and timely processing based on contract pricing and payer models.
7. Mail Management: Manage and distribute incoming mail accurately and promptly, including Epic documentation, logging correspondence, and routing misdirected mail.
8. Problem Solving: Communicate any problems hindering workflow to management and provide suggestions to increase efficiency.
9. Customer Service: Provide excellent customer service to patients, employees, vendors, and auditors, addressing their inquiries and concerns professionally.
10. Continuous Learning: Participate in educational programs to meet mandatory requirements and identified needs regarding job and personal growth.

Why Remote Work at WVU Medicine?

Working remotely as a Clinical Denials Specialist at WVU Medicine offers several advantages:

• Flexibility: Enjoy a flexible work schedule that allows you to balance your professional and personal life.
• Convenience: Save time and money by eliminating the daily commute.
• Productivity: Create a comfortable and efficient workspace in your home environment.
• Accessibility: Access the resources and support you need to perform your job effectively from anywhere with an internet connection.
• Work-Life Balance: Achieve a better work-life balance, reducing stress and improving overall well-being.

Career Path

The Clinical Denials Specialist role can be a stepping stone to various career paths within WVU Medicine’s revenue cycle department. Potential career advancements include:

• Senior Clinical Denials Specialist: Take on more complex denial cases and provide guidance to junior specialists.
• Denial Management Supervisor: Oversee a team of denial specialists, managing their performance and ensuring adherence to policies and procedures.
• Revenue Cycle Analyst: Analyze denial trends and identify opportunities for process improvement to reduce denials and increase revenue recovery.
• Compliance Officer: Ensure the organization complies with all relevant billing and coding regulations.
• Revenue Cycle Manager: Manage various aspects of the revenue cycle, including billing, coding, and collections.

Salary & Benefits

WVU Medicine offers a competitive salary and benefits package for the Clinical Denials Specialist position. The estimated salary range for this role is $38,000 to $58,000 per year, depending on experience and qualifications. In addition to salary, WVU Medicine provides a comprehensive benefits package, including:

• Health Insurance: Comprehensive medical, dental, and vision coverage.
• Paid Time Off: Generous PTO for vacation, sick leave, and holidays.
• Retirement Plan: Retirement plan with employer matching contributions.
• Life Insurance: Life insurance and disability coverage.
• Employee Assistance Program: EAP for mental health and well-being support.
• Tuition Reimbursement: Tuition assistance for continuing education.
• Professional Development: Opportunities for professional development and training programs.
• Employee Discounts: Employee discounts on WVU Medicine services and products.
• Wellness Programs: Wellness programs and resources to promote a healthy lifestyle.
• Flexible Spending Accounts: FSAs for healthcare and dependent care expenses.
• Career Growth: Opportunities for advancement and career growth within WVU Medicine.
• Supportive Environment: A supportive and collaborative work environment.
• Competitive Salary: A competitive salary and compensation package
• Employee Referral Program: Employee referral program with potential bonuses
• Relocation Assistance: Relocation assistance (if applicable)
• Commuter Benefits: Commuter benefits for transportation costs

WVU Medicine Culture

WVU Medicine is committed to providing high-quality patient care and fostering a positive work environment for its employees. The organization values teamwork, respect, and continuous improvement. As a Clinical Denials Specialist, you will be part of a dedicated team working together to achieve excellence in revenue cycle management.

How to Apply

To apply for the Clinical Denials Specialist position at WVU Medicine, please follow these steps:

1. Click the “Apply” button at the top of this page.
2. Complete the application form, providing accurate and detailed information about your qualifications and experience.
3. Upload your resume and cover letter, highlighting your relevant skills and experience in medical billing, coding, and insurance processing.
4. Submit your application and await further instructions from the WVU Medicine hiring team.

Frequently Asked Questions (FAQ)

1. What are the minimum qualifications for this position?

   The minimum qualifications include a High School diploma or equivalent and one year of training in medical billing, coding, insurance processing, or related experience.

2. What are the preferred qualifications?

   Preferred qualifications include an Associate degree in a related field, knowledge and experience with EPIC medical billing, and experience with Microsoft Excel/Word.

3. Is prior hospital billing experience required?

   While not required, prior experience with hospital billing is preferred.

4. What skills are essential for this role?

   Essential skills include medical billing, coding, insurance processing, denial investigation, appeals writing, account adjustments, compliance knowledge, customer service, and communication skills.

5. What software and tools will I be using?

   You will be using EPIC medical billing software, payer portals and websites, and Microsoft Office applications.

6. What is the work environment like?

   This is a remote position, allowing you to work from home while collaborating with a team of professionals.

7. What opportunities are there for professional development?

   WVU Medicine offers opportunities for professional development and training programs to enhance your skills and knowledge.

8. How does WVU Medicine support employee well-being?

   WVU Medicine provides an Employee Assistance Program (EAP) for mental health and well-being support and offers wellness programs to promote a healthy lifestyle.

9. What is the career path for this role?

   Potential career advancements include Senior Clinical Denials Specialist, Denial Management Supervisor, Revenue Cycle Analyst, Compliance Officer, and Revenue Cycle Manager.

10. What is the application process?

    The application process involves completing the online application form, uploading your resume and cover letter, and submitting your application for review.