Insurance Claims Specialist

UNTWN Uniontown Hospital - Uniontown, PA

Full-time

Uniontown, PA

About the position

The Insurance Claims Specialist is responsible for managing the process of patient account review, correction, adjustment, and filing claims to third-party payers and/or patients. This role involves direct interaction with patients and third-party payers to ensure accurate information distribution and timely resolution of claims.

Responsibilities

• Performs claims processing to third party payer according to payer guidelines.
• Reviews and corrects billing edits prior to submitting claims.
• Reviews edits to ensure proper billing and verifies edits with the appropriate Department leaders, if needed.
• Works denials thoroughly and timely with little back-log.
• Performs follow up on account, working with third party payers, patient, employer, and physician office to resolve unpaid or underpaid accounts.
• Communicates problems hindering workflow to management in a timely manner.
• Posts copays collected at Medical Offices to vouchers and maintains unassigned payments.
• Processes collections accounts.
• Processes patient and insurance refund documentation.

Requirements

• High school diploma or equivalent.
• West Virginia state criminal background check required, and Federal, if applicable, for DHHR BMS regulated area.
• Previous hospital billing and/or credit and collection experience.