Teams at WVU Medicine

Manage patient account balances through accurate claim submission, payer follow-up, denial management, and account reconciliation. Use payer portals and phone/email to resolve unpaid or rejected claims, maintain productivity metrics, comply with HIPAA, and support revenue cycle reporting and improvement initiatives.

Obtains prior authorizations and verifies insurance eligibility for elective procedures, tests, referrals, and surgeries. Reviews clinical documentation, medical policies, ICD-10 and CPT coding, and payer requirements. Follows up on authorization requests, denials, appeals, peer-to-peer reviews, and retro-authorizations. Communicates authorization status and financial clearance risks to providers, schedulers, and financial services while maintaining Epic work queues, productivity standards, confidentiality, and timely service clearance.

Manages hospital patient account balances through accurate claim submission, payer follow-up, denial resolution, billing reconciliation, and compliance with federal, state, HIPAA, and third-party billing requirements. Uses payer portals to verify claim status, researches rejected claims, maintains account records, prepares reports, and supports revenue cycle goals. Provides customer service to patients and staff while maintaining confidentiality and productivity standards.