Denial Specialist

RiseMe; Saint Paul (MN); On-site; USD 52,000 - 68,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Retirement Plan

Time Off

Tuition Reimbursement

Employee Assistance Program

Onsite Clinic

Job summary

HealthPartners in Minnesota is seeking a Claims Specialist to manage insurance and third-party claim submissions and payments, ensuring compliance with payer requirements. Responsibilities may include pre-adjudication, claim follow-up, and handling facility or professional claims for commercial and government payers.

Strong detail orientation, clear communication, and proficiency with MS Office are essential; familiarity with Epic and healthcare revenue cycle processes is preferred.

Qualifications

• Attention to detail and problem resolution skills.
• Clear verbal and written communication abilities.
• Proficiency with MS Office and general PC skills.
• Experience with healthcare revenue cycle processes is preferred.

Responsibilities

• Submit and follow up on insurance/3rd party claims in a timely manner.
• Handle pre-adjudication and follow-up activities as needed.
• Manage facility and/or professional claims for commercial/government payers.
• Ensure compliance with applicable regulations and payer requirements.

Skills

Attention to detail

Verbal & written communication

Microsoft Office

Office equipment

Healthcare revenue cycle knowledge

CPT/ICD coding familiarity

Education

Experience in healthcare revenue cycle environment

Tools

Epic

Job description

Park Nicollet is looking to hire a Claims Specialist to join our team! Come join us as a Partner for Good and help us make an impact on the care and experience that our patients and their families receive every day.

Position Summary:

This position ensures that insurance and other 3rd party claims are submitted and/or paid in a timely manner and are compliant with applicable regulations and payer requirements. Specific assignments may include pre-adjudication and/or follow-up, facility and/or professional claims, commercial and/or government payers. Effective performance of these functions helps the organization achieve strong cash flow and maximize patient satisfaction.

Required Qualifications:

Knowledge, Skills, and Abilities:

• Requires strong attention to detail and demonstrated problem resolution skills.
• Must be able to effectively communicate verbally and via written documents.
• Moderate personal computer proficiency with word processing, spreadsheets and email is required (preference for Microsoft Suite).
• Working knowledge of typical office equipment is expected.

Preferred Qualifications:

Education, Experience or Equivalent Combination:

• Experience in a health care revenue cycle environment preferred.

Knowledge, Skills, and Abilities:

• Ability to acquire and retain complex knowledge of department/company processes, government policy/regulation, and payer requirements.
• Prior medical terminology and procedural/diagnostic coding (CPT, ICD) knowledge will be helpful.
• Proficiency with Health Information Systems (e.g., Epic) preferred.

Benefits:

Park Nicollet offers a competitive benefits package (for eligible positions) that includes medical insurance, dental insurance, a retirement program, time away from work, insurance options, tuition reimbursement, an employee assistance program, onsite clinic and much more!

At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.