Clinical Denials Specialist

About This Role

Manage accounts receivable related to denied claims for WVU Medicine hospitals. This role ensures financial viability through investigation, follow-up, and non-clinical appeal writing while maintaining compliance with regulations.

Responsibilities

• Accurately triage and route claims to work queues
• Follow up with third party payers to clarify payment issues and ensure timely appeal resolution
• Utilize payer portals and websites to verify appeal status and conduct account follow-up
• Compose administrative, non-clinical appeals as directed by leadership
• Develop and maintain working knowledge of federal, state, and local billing compliance regulations
• Maintain work queue volumes and productivity within established standards
• Post adjustments as directed or by following department SOP
• Manage and distribute incoming mail in an accurate and timely manner
• Communicate problems hindering workflow to management
• Participate in educational programs to meet mandatory requirements and identified needs

Requirements

• High School diploma or equivalent
• One (1) year of training in medical billing, coding, insurance processing, or other related experience

Qualifications

• High School diploma or equivalent
• One (1) year of training in medical billing, coding, insurance processing, or other related experience.

Nice to Have

• Associate degree in related field
• Knowledge and experience with EPIC medical billing
• Experience with Microsoft Excel/Word
• Experience with hospital billing
• Knowledge of medical terminology
• Good verbal and writing skills
• Basic mathematical skills
• Excellent telephone skills
• Ability to type at least 35 WPM

Skills

* Required skills