Insurance and Claims Specialist

Renown Health • Reno, NV

17h

About The Position

The Insurance and Claims Specialist reviews and corrects claim errors to support accurate, timely claim submission, account follow-up, and reimbursement on the first claim submitted. The Specialist appeals healthcare claims denied by third-party payors, handles difficult or hard-to-collect accounts deemed unpayable by insurers, analyzes and resolves incorrect reimbursement issues, and resolves credit balances with payors.

The position requires knowledge of state and federal regulations relating to contracts, appeals, and government payor billing and follow-up, including CCI, LCD/NCD, and medical necessity rules. The Specialist works within policy and procedural guidelines to ensure accurate accounts receivable reporting and compliance with Renown Health policies and objectives. This position does not provide patient care.

Requirements

• Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively.
• One year of healthcare billing office experience with extensive knowledge of healthcare billing and government and third-party payor requirements. An associate degree or certification in an accredited billing program may be accepted in lieu of years of experience.
• Proficiency with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word.
• Ability to use a computer to complete online learning requirements, access online forms and policies, and complete online benefits enrollment.

Nice To Haves

• Associate degree preferred.

Responsibilities

• Work assigned work queues to correct errors and support accurate claims and reimbursement on first claim submission.
• Audit denials and payment variances to identify root causes and make corrections as needed.
• Audit payment variances to ensure appropriate reimbursement.
• Apply detailed contract knowledge to support maximum reimbursement of healthcare claims.
• Resolve credit balances by reviewing payments, adjustments, or transfers and correcting patient accounts to reflect accurate accounts receivable balances.
• Work with leadership and internal departments to improve processes, increase accuracy, create efficiencies, and decrease denials.
• Maintain current knowledge of CPT/HCPCS, ICD, DRG, and HCFA forms, and the ability to manipulate and analyze 837 and other HIPAA transaction sets.
• Follow applicable policies and procedures to ensure accurate accounts receivable reporting and compliance.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed