Claims Resolution Specialist

Prominence-Health-Plan; Reno (NV); On-site; USD 60,000 - 75,000; Full time

Job summary

Prominence Health is seeking a Claims Resolution Specialist in Reno, NV to analyze and resolve complex claims issues, ensuring accurate processing and timely reimbursement for healthcare services.

The role requires strong knowledge of CPT, ICD-10 and CDT coding, plus 3+ years in health care claims processing and excellent communication to coordinate with providers and members.

Qualifications

• High School Diploma or GED required; an Associate degree is preferred.
• Thorough knowledge of CPT, ICD-10 and CDT coding.
• 3+ years of health care claims processing experience, preferably in Medicare.
• Certified coder preferred (CCA or CCS) or ability to obtain certification within one year.

Responsibilities

• Analyze and resolve complex claims issues to ensure timely reimbursement.
• Ensure claims are processed accurately and in compliance with billing procedures.
• Communicate effectively with providers, patients and internal teams to resolve discrepancies.
• Maintain organized documentation and meet deadlines in a fast-paced environment.

Skills

CPT coding

ICD-10 coding

CDT coding

Claims processing

Customer service

Communication

Education

High School Diploma or GED

Associates degree preferred

Tools

Microsoft Office Suite

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary

The Claims Resolution Specialist is a pivotal role in ensuring the efficient and accurate processing of healthcare claims. Primary responsibilities will be to analyze and resolve complex claims issues, ensuring timely reimbursement for healthcare services provided. This role demands a deep understanding of healthcare billing and insurance procedures, exceptional attention to detail, and excellent communication skills. In this role, you will contribute by ensuring claims are processed accurately and efficiently. Your dedication to resolving claims issues will have a direct impact on the overall success of Prominence Health.

Benefit Highlights

• Loan Forgiveness Program


• Challenging and rewarding work environment


• Competitive Compensation & Generous Paid Time Off


• Excellent Medical, Dental, Vision and Prescription Drug Plans


• 401(K) with company match and discounted stock plan


• SoFi Student Loan Refinancing Program


• Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

Qualifications and Requirements

• · High School Diploma or GED required. Associates degree preferred.


• · Thorough knowledge of CPT, ICD-10 and CDT coding and medical terminology.


• · 3+ years’ experience in health care claims processing, preferably in a Medicare environment, including customer service experience.


• · Ability to plan, organize, maintain priorities and schedules, as well as assure that deadlines are met.


• · Certified coder preferred CCA or CCS designation or must be able to obtain certification within one year of employment.


• · Excellent verbal and written communication skills.


• · Ability to interpret health plan benefits and provider contracts.


• · Must be able to deal with difficult customers in a professional manner.


• · Ability to interpret and apply established policies and procedures.


• · Excellent computer skills which must include working knowledge of Microsoft Office Suite.


• · Must be a team player and have the ability to work independently with little supervision.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.