Title: Insurance Claims Specialist HB Location: Home Work - Monongalia County WV (Local) time type Full time job requisition id JR26-35859 Job Description: Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all federal/state and third party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the WVU Medicine hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to achieve best in class revenue cycle operations. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. High School diploma or equivalent. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. One (1) year medical billing/medical office experience. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Submits accurate and timely claims to third party payers. 2. Resolves claim edits and account errors prior to claim submission. 3. Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals. 4. Gathers statistics, completes reports and performs other duties as scheduled or requested. 5. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency. 6. Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up. 7. Contacts third party payers to resolve unpaid claims. 8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up. 9. Assists Patient Access and Care Management with denials investigation and resolution. 10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth. 11. Attends department meetings, teleconferences and webcasts as necessary. 12. Researches and processes mail returns and claims rejected by the payer. 13. Reconciles billing account transactions to ensure accurate account information according to established procedures. 14. Processes billing and follow-up transactions in an accurate and timely manner. 15. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing. 16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts. 17. Maintains work queue volumes and productivity within established guidelines. 18. Provides excellent customer service to patients, visitors and employees. 19. Participates in performance improvement initiatives as requested. 20. Works with supervisor and manager to develop and exceed annual goals. 21. Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information. 22. Communicates problems hindering workflow to management in a timely manner. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Must be able to sit for extended periods of time. 2. Must have reading and comprehension ability. 3. Visual acuity must be within normal range. 4. Must be able to communicate effectively. 5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. SKILLS AND ABILITIES: 1. Excellent oral and written communication skills. 2. Working knowledge of computers. 3. Knowledge of medical terminology preferred. 4. Knowledge of business math preferred. 5. Knowledge of ICD-10 and CPT coding processes preferred. 6. Excellent customer service and telephone etiquette. 7. Ability to use tact and diplomacy in dealing with others. 8. Maintains knowledge of revenue cycle operations, third party reimbursement and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures. 9. Ability to understand written and oral communication. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 544 SYSTEM Patient Financial Services

Title: Revenue Cycle Specialist Location: Franklin United States Job Description: Our Benefits: - Comprehensive Medical, Dental, & Vision insurance - Competitive 401(k) plan with company match - Company paid group term life insurance and short-term disability - Generous PTO: Paid vacation, personal time, sick Leave, and extended sick leave - Employee Assistance Program (EAP) offering continued support to employee lifestyle and well-being - Career advancement opportunities across a leading national network Job Responsibilities: - Responsible for updating patient Billing Episodes and crediting account, as appropriate. - Review and resolve prior authorization/precertification/referral issues that are not valid and contact insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial. - Validates all necessary referrals/prior authorizations/pre-certifications for scheduled services are on file and shared with all appropriate staff and are valid for the scheduled services performed. - Ensure all account activity is documented in the appropriate system and shared with all appropriate staff timely and thoroughly. - Clinic Emails – responsible for managing clinic emails throughout the day. All clinic emails must be responded to in a timely manner. - Identify, Correct and forward potential reimbursement problems to Revenue Cycle Manager. - Proactively interacts with Clinics and other appropriate staff sharing benefits, authorizations, and eligibility. - Responsible for billing all patient claims in a timely manner (weekly billing, secondary and out-of-network plans). - Review claims issues make corrections as needed and rebill. Utilize claims clearinghouse, EMRs and payor portals to review and correct claims and to resubmit electronically when available. - Responsible for evaluating bill cycles and changing/updating when necessary. - Responsible for printing daily billing reports – both electronic and paper claims. Monitor validation percent. - Work daily claims rejection lists including but not limited to; claims rejected due to auto eligibility process during weekly billing and “Rejected” claims due to eligibility, coordination of care and authorization as part of accounts receivable. - Gathers and interprets data from the system and understands appropriate courses of action to take and initiates time-sensitive and strategic steps resulting in payment. - Call and status outstanding claims with third party payors. - Review explanation of benefits to ascertain that claim processed and paid correctly. - Document account follow-up where appropriate. - Identify trends and work with the Revenue Cycle Manager for resolution. - Perform other duties as assigned. Your Education, Skills, & Qualifications: - High school diploma or equivalent; prefer some college or technical school coursework. - 2+ years of healthcare billing/AR experience, preferred. - Healthcare payor claims follow-up or accounts receivable experience. - Healthcare background with payor appeals experience. - Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint. - Knowledge of office administration procedures with the ability to operate most standard office equipment. - Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality. - Excellent interpersonal skills include the ability to interact effectively and professionally with individuals at all levels; both internal and external. - Exercises sound judgment in responding to inquiries; understands when to route inquiries to the next level. - Self-motivated with strong organizational skills and superior attention to detail. - Must be able to manage multiple tasks/projects simultaneously within inflexible time frames. Ability to adapt to frequent priority changes. - Capable of working within established policies, procedures and practices prescribed by the organization. - English sufficient to provide and receive instructions/directions. We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

Role Description The Career Transition Assistance Plan (CTAP) provides eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation and be found well-qualified (have a final rating of 85 or more before any Veterans preference points) for this vacancy. This position is located in the Education Call Center Division within the Department of Veterans Affairs, Regional Processing Office (RPO) in Muskogee, OK. The Veterans Claims Examiner reviews education awards to ensure proper payment, eligibility, and entitlement regulations and laws have been applied in processing the education award. Advises education claimants and their representatives-via telephone of their benefits, rights, and privileges which they are entitled to under the laws administered by VA in a high-volume call center. Must possess the technical and communication skills to effectively carry out the duties of this position. - Assists individuals in developing needed evidence, preparing required documentation, and resolving errors and/or delays in obtaining benefits. - Explains the types of documents necessary to facilitate timely processing of claims and assists in obtaining and completing such documents and forms in accordance with the type of claim being submitted. - Responsible for counseling veterans, their dependents, and beneficiaries via telephone in a high-volume call center regarding the full range of education benefits through the Department of Veterans Affairs. - Explores all avenues of assistance available to veterans, beneficiaries, and dependents and takes initiative to encourage individuals to fully utilize these benefits. - Researches issue(s) to include direct contact with RO of jurisdiction if warranted, or in course of research, with other Federal or state agencies as necessary. - Explains decisions and reasons for decisions made by the VA and communicates verbally this information to the claimant. - Informs individuals of their right to appeal decisions and explains the appeal process. - Provides advice, expertise, and problem-solving assistance to claimants who call the National Education Call Center using discretion and tact when communicating negative or stressful information. - Exhibits the ability to complete the contact independently and refer few calls to a higher level. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. The grade progression for this position is GS-05, GS-07, GS-09. Work Schedule: Full time, Monday through Friday 8:00 - 4:30 pm CST during training. Upon completion of training, work schedule will be Full time, Monday through Friday 10:00 - 6:30pm CST. Compressed/Flexible: Not available Telework: Not available, this is a remote position Virtual: This is not a virtual position. Position Description Title/PD#: Veterans Claims Examiner; PD37923A and PD37924A Relocation/Recruitment Incentives: Not Authorized Financial Disclosure Report: Not required Qualifications - To qualify for this position, applicants must meet all requirements by the closing date of this announcement: 06/15/2026. - GRADE REQUIREMENT: To receive CTAP selection priority, your grade level upon Reduction in Force must be at least GS-05, GS-07 with promotion potential of at least GS-9. - MINIMUM QUALIFICATIONS: - GS-05 Grade Level: - Specialized Experience: Applicants must have three years of progressively responsible experience, one year of which was equivalent to at least the GS-04. - General experience is defined as experience that demonstrates the ability to: - Analyzing problems to identify significant factors, gather pertinent data; and recognizing solutions; - Planning and organizing work; - Communicating effectively orally and in writing. - Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have: 4 year course of study leading to a bachelor's degree. - GS-07 Grade Level: - Specialized Experience: Applicants must have one year of specialized experience equivalent to at least the next lower grade in the normal line of progression (GS-5). - Specialized experience for this position is defined as: Counseling individuals about federal, state, or local benefits by explaining legal provisions, regulations, or decisions to a variety of audiences. - Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have: 1 full year of graduate level education or superior academic achievement. - Combining Education & Experience: If you do not fully meet the length of experience and education described for a specific grade level, the two can be combined to total 100% of the requirement. - Volunteer Experience: Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Requirements - Full-time employment is considered to be at least 35 hours per week. - Part-time experience will be credited on a pro-rated basis; when including part-time employment in your resume you must specify the average hours worked per week. - Physical Requirements: The work is primarily sedentary. The EBS will be required to talk for long periods of time, which occasionally puts a strain on the throat/vocal cords. - There are no other special physical demands required to perform the work. - There may be some walking, standing, and carrying of light items such as papers, books, claims folders, and files from one desk to another or for returning to storage. - Extensive use of a computer and a telephone with a headset is required.

• Conduct both virtual and on-site investigations by visiting policyholders’ residences to assess property damage, determine liability, evaluate the extent of loss, and negotiate fair settlements. • Use claims handling software, a company car, and a laptop to determine claims-related damage and write estimates in a paperless environment. • Evaluate and report on potential subrogation opportunities. • Perform duties independently, with work directly impacting management outcomes. • Acts as a company representative in public interactions, maintaining a professional demeanor consistent with management standards. • Engages regularly with a variety of stakeholders, including policyholders, claimants, agents, witnesses, contractors, law enforcement, fraud and arson investigators, attorneys, medical professionals, and other relevant parties. • Use strong customer service skills to negotiate with policyholders to settle the claim.