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　　Come join our Peak Health team at WVU Medicine as a Medicare Insurance Claims Processer, contributing to the foundation for an innovative, new health plan. This position will report to the Medicare Claims Supervisor, playing a unique and important role in our mission to change healthcare for the better. Experience in the healthcare industry and critical thinking skills will help the organization build an effective and efficient claims team. The claims team reviews and oversees the adjudication of claims ranging from simple data entry to complex specialty claim research. The Medicare Claims team analyzes and processes insurance claims, checking for validity in accordance with all CMS guidelines. Ability to determine whether to return, deny, or pay claims while following organizational policies and procedures is a must. This job screens, reviews, evaluates online entry, error correction, and quality control for final adjudication of paper/electronic claims.

　　MINIMUM QUALIFICATIONS:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. Associate Degree in related healthcare field or high school diploma and 3 (three) years of healthcare claims billing and processing experienceEXPERIENCE:1. At least 1 (one ) year of Medicare claims processing experience2. At least 1 (one) year of experience working with CMS/professional and UB/institutional claims3. At least 1 (one) year of customer service experience4. Working knowledge of Medicare medical insurance terminology, procedure, diagnosis codes and HIPPA requirements

　　PREFERRED QUALIFICATIONS:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. Bachelor's degree in medical coding or related healthcare field, OR 4 (four) years of equivalent industry work experienceEXPERIENCE:1. 3 (three) plus years of Medicare claims processing experience2. 3 (three) plus years of medical or institutional claims processing and customer service experience3. Experience in Medicare medical insurance and Medicare supplement preferred4. Familiarity navigating the EPIC software programs

　　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. Ensure accuracy of data entered and record maintenance2. Analyze claims to determine the extent of insurance carrier liability3. Resolve claim edits, review history records, and determine benefit eligibility for service4. Review payment levels to arrive at final payment determination5. Interpret contract benefits and adjudicate claims... For full info follow application link.

　　Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

　　The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)