Teams at WVU Medicine

Manages hospital patient account balances through accurate claim submission, payer follow-up, denial resolution, billing reconciliation, and compliance with healthcare billing regulations. Uses payer portals to verify claim status, resolves account errors and rejected claims, processes transactions, maintains reports and work queues, and supports revenue cycle operations. Provides customer service while protecting patient information under HIPAA requirements.

Processes and adjudicates medical and institutional insurance claims by verifying data, resolving edits, determining benefit eligibility, reviewing payment levels, and making final pay, deny, or return decisions. Maintains accuracy, quality, productivity, and records while communicating with internal and external stakeholders. Requires attention to detail, medical insurance knowledge, basic medical terminology, mathematics, customer service, and the ability to navigate multiple systems.

Provides financial, reimbursement, reporting, and regulatory compliance analysis for outpatient services across WVU Medicine. Analyzes CMS provider-based and rural health clinic requirements, evaluates reimbursement impacts, conducts onsite gap assessments, interprets legislation, and advises leadership on compliance changes. The role develops reporting packages, supports data analytics and problem resolution, educates hospital personnel, and communicates business concepts to clinical and operational stakeholders.