Sr Insurance and Claims Specialist
- Requisition ID
- 186955
- Department
- 100620 Hospital Billing Services
- Schedule
- Full Time - Eligible for Benefits
- Shift
- Day
- Category
- Clerical & Administrative Support
- Salary
- 22.16 - 31.03
Position Purpose
The Senior Insurance and Claims Specialist is responsible for compliant billing, account follow up and system operations to ensure timely and accurate claim submission and prevention of denials per regulatory and payor requirements, as well as improved payment turnaround.
Nature and Scope
The Senior Insurance and Claim Specialist is responsible for:
• Optimization of system that will ensure accurate claim submission and follow-up resulting in timely reimbursement per payor and regulatory guidelines.
• Complete detailed appeal of denial or payment variance to payor, incorporating contract terms, clinical or regulatory justification for reconsideration or additional reimbursement.
• Recommend system changes for clean claim submission to aid in the prevention of denials.
• Work with the Renown Contracting Department or payor representatives to resolve billing issues due to payor or regulatory changes affecting the billing of healthcare claims.
• Assisting with testing and troubleshooting of system for payor or regulatory changes.
• Maintaining expertise for all payor, HIPAA and other regulatory changes affecting the billing of healthcare claims.
• Working hand in hand with Operations Analysts and Information Technology to maintain and improve business system changes based on payor or regulatory changes.
• Acts as a resource for staff on all areas relating to edit and denial/rejection resolution.
• Identify trends in payor non-compliance and inform management if not able to resolve with payor.
• Demonstrates a thorough knowledge of all department functions, processes, and procedures.
This position does not provide patient care.
Disclaimer
The foregoing description is not intended to be, and should not be construed as, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
Name | Description |
|---|---|
Education: | Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates Degree Preferred. |
Experience: | Two years healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. |
License(s): | None |
Certification(s): | Coding Certification Preferred for Professional Billing. |
Computer / Typing: | Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. |
Benefits
Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.
With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.
Paid Time Off
401(k) Company Match
Flexible Work Environment
Renown Health is northern Nevada's healthcare leader and Reno's only locally owned, not-for-profit health system. We are an entire network of hospitals, primary care offices, urgent care centers, lab services, medical specialties, and x-ray and imaging services - with more than 7,000 nurses, doctors and care providers dedicated to the health and well-being of our community.
For Providers: Renown Health and the University of Nevada, Reno School of Medicine (UNR Med) are affiliate partners in Nevada's first integrated academic health system. The affiliation aims to improve the health of the community, region, and state through research, medical education, and expanded clinical care. Renown physicians participate as joint faculty at UNR Med for teaching, lectures, supervising clinical rotations, and other academic activities for the education of medical and physician assistant students, residents and fellows.