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MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent required.

EXPERIENCE:

1. Correspondence processing.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Knowledge of healthcare billing, insurance processes, and payer guidelines.

2. Experience with insurance denials, appeals, and claim resolution processes.

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. Receive, review, and process all incoming correspondence related to billing, insurance claims, denials, appeals, and patient inquiries.

2. Process outgoing mails including but not limited to claims, itemized bills and medical records as required.

3. Draft, edit, and send responses to insurance companies, patients, and internal departments following established guidelines and policies.

4. Maintain accurate records of all correspondence in electronic document management systems or revenue cycle software.

5. Track, monitor, and escalate unresolved correspondence issues to appropriate revenue cycle teams for resolution.

6. Collaborate with billing, coding, collections, and patient financial services teams to gather necessary information for correspondence responses.

7. Ensure all correspondence complies with HIPAA regulations and organizational confidentiality standards.

8. Support denial management by generating appeal letters and coordinating necessary documentation.

9. Assist in audit preparation by organizing correspondence records and documentation.

10. Maintain templates and update correspondence formats as needed to reflect current policies and payer requirements.

11. Provide regular reports on correspondence volume, status, and resolution metrics.

12. Other Revenue Cycle supporting tasks and duties as assigned.

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 have manual dexterity to operate keyboards, fax machines, telephones and other business equipment.

5. Must be able to lift 50 pounds within handling package storage.

6. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift.

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.

2. Home office.

SKILLS AND ABILITIES:

1. Strong written communication skills with excellent grammar, spelling, and attention to detail.

2. Ability to manage multiple priorities and deadlines in a fast-paced environment.

3. Proficient in Microsoft Office Suite, especially Word and Outlook.

4. Strong organizational and record-keeping skills.

5. Understanding of HIPAA and patient privacy laws.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.