Claims Coding, Billing and Collection Services

The West Virginia Office of Shared Administration, on behalf of the Department of Health Facilities (DHF), is soliciting vendors to provide an open‑end contract for comprehensive inpatient and outpatient claims coding, billing, and collection services for three state‑owned hospitals. Work will be performed remotely; the vendor must supply staffing, secure interfaces to the facilities’ electronic health record (Medsphere CareVue) and billing systems (Optimum), and manage end‑to‑end revenue cycle activities including coding, claim submission, denial management, patient statements, and collections. The contract requires compliance with HIPAA, OIG, and state regulations, and the vendor must begin services within 30 days of award and maintain performance metrics (≥92‑95% first‑pass claim resolution, ≤11% error rate). Monthly reporting, a toll‑free support line, and a designated contract manager are also required. • Remote, off‑site coding, billing and collection for three WV state hospitals (psychiatric and acute care). • Required integration with CareVue EMR, Optimum RCM, and Availity clearinghouse (HL7, EDI). • Minimum 5 years experience in hospital billing; staff must hold AHIMA/AAPC credentials. • Vendor must start within 30 calendar days of award and provide monthly staffing and performance reports. • Performance standards: ≥92‑95% clean‑claim rate, ≤11% error rate, 98% coding accuracy. • Monthly invoicing based on a percentage of monies collected from a projected $2 M annual collection pool. • Mandatory compliance with HIPAA, SOC 2 Type II/HITRUST, and state regulations; must maintain audit logs and breach response plan. • Provide 24/7 toll‑free patient support, monthly quality‑assurance audits, and detailed financial reporting.