Lead Insurance Claims Specialist at WVU Medicine - Remote Opportunity

Role Overview

The Lead Insurance Claims Specialist at WVU Medicine plays a crucial role in ensuring the financial health of the organization by managing patient account balances, accurately submitting claims, and diligently following up with third-party payers. This remote position requires a detail-oriented individual with a strong understanding of medical billing processes, insurance regulations, and revenue cycle management. The ideal candidate will possess excellent communication skills, a proactive approach to problem-solving, and the ability to work independently while collaborating with a team.

A Day in the Life

As a Lead Insurance Claims Specialist, your day will be filled with a variety of tasks aimed at maximizing revenue collection and maintaining compliance. Here's a glimpse into your daily routine: * **Claim Submission:** You'll prepare and submit accurate claims to various insurance companies, ensuring all necessary information is included to avoid rejections. * **Claim Follow-Up:** You'll proactively follow up on outstanding claims, using payer portals and websites to check claim status and address any issues. * **Denial Management:** You'll investigate and resolve claim denials, working with Patient Access and Care Management to gather supporting documentation and appeal decisions. * **Account Reconciliation:** You'll reconcile billing account transactions to ensure accurate account information and identify any discrepancies. * **Customer Service:** You'll respond to inquiries from patients, insurance companies, and internal stakeholders, providing clear and concise information and resolving any concerns. * **Report Generation:** You'll generate reports to track key performance indicators (KPIs) and identify areas for improvement in the claims process. * **Compliance:** You'll stay up-to-date on the latest billing regulations and ensure all activities comply with federal, state, and local guidelines.

Why Remote?

This position offers the flexibility of working remotely, allowing you to manage your time and work from the comfort of your home. WVU Medicine is committed to providing a supportive remote work environment, with the necessary technology and resources to ensure your success. Remote work can improve work-life balance, reduce commuting stress, and increase overall job satisfaction.

Career Path

WVU Medicine is dedicated to the growth and development of its employees. As a Lead Insurance Claims Specialist, you'll have opportunities to advance your career within the revenue cycle department. Potential career paths include: * **Senior Insurance Claims Specialist:** Taking on more complex claims and mentoring junior team members. * **Claims Supervisor:** Overseeing a team of claims specialists and ensuring performance goals are met. * **Revenue Cycle Analyst:** Analyzing data to identify trends and opportunities for improvement in the revenue cycle process. * **Revenue Cycle Manager:** Managing a team of analysts and supervisors to optimize revenue collection.

Salary & Benefits

WVU Medicine offers a competitive salary and benefits package to attract and retain top talent. The estimated salary range for this position is $45,000 - $65,000 per year, depending on experience and qualifications. In addition to salary, employees enjoy a comprehensive benefits package, including: * **Health Insurance:** Medical, dental, and vision coverage. * **Paid Time Off:** Vacation, sick leave, and holidays. * **Retirement Plan:** 401(k) with employer matching contributions. * **Life Insurance:** Basic and supplemental life insurance options. * **Disability Coverage:** Short-term and long-term disability benefits. * **Flexible Spending Accounts:** Healthcare and dependent care FSAs. * **Tuition Reimbursement:** Assistance with continuing education. * **Employee Assistance Program:** Confidential counseling and support services.

WVU Medicine Culture

WVU Medicine is committed to creating a welcoming and inclusive workplace where every employee feels valued and respected. The organization fosters a culture of teamwork, collaboration, and continuous improvement. Employees are encouraged to share their ideas, contribute to the success of the organization, and make a difference in the lives of patients and families.

How to Apply

If you're a motivated and experienced insurance claims professional looking for a challenging and rewarding opportunity, we encourage you to apply! To apply for the Lead Insurance Claims Specialist position, please submit your resume and cover letter through the WVU Medicine careers website. Be sure to highlight your relevant experience and qualifications, and explain why you're a good fit for the role.

Frequently Asked Questions (FAQ)

**1. What are the essential qualifications for this position?** The essential qualifications include a high school diploma or equivalent, six years of medical billing/medical office experience, nine months of experience directly working with hospital insurance claims, and the ability to obtain HFMA CRCR certification within 90 days of hire. **2. Is this position fully remote?** Yes, this position is fully remote, allowing you to work from home. **3. What are the working hours for this position?** The typical working hours are Monday through Friday, 8:00 AM to 5:00 PM, but may vary depending on the needs of the department. **4. What type of training will I receive?** You'll receive comprehensive training on WVU Medicine's billing systems, policies, and procedures, as well as ongoing training on industry best practices and regulatory changes. **5. What opportunities are available for career advancement?** WVU Medicine offers opportunities for career advancement within the revenue cycle department, including positions such as Senior Insurance Claims Specialist, Claims Supervisor, and Revenue Cycle Analyst. **6. What is the dress code for remote employees?** While working remotely, you're expected to maintain a professional appearance during virtual meetings and interactions with colleagues and external stakeholders. **7. What technology and equipment will I need to work remotely?** WVU Medicine will provide you with the necessary computer equipment, software, and access to internal systems to perform your job effectively. **8. What is the company culture like at WVU Medicine?** WVU Medicine fosters a culture of teamwork, collaboration, and continuous improvement, where employees are encouraged to share their ideas and contribute to the success of the organization. **9. What are the benefits of working at WVU Medicine?** WVU Medicine offers a comprehensive benefits package, including health insurance, paid time off, retirement plan, life insurance, disability coverage, flexible spending accounts, and tuition reimbursement. **10. How can I learn more about WVU Medicine?** You can learn more about WVU Medicine by visiting our website, following us on social media, and reading employee testimonials.