Insurance and Claims Specialist

Renown Health; Nevada; On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Education Assistance

Paid Time Off

401(k) Company Match

Flexible Work Environment

Job summary

Renown Health is seeking an Insurance and Claims Specialist to review and correct claim errors, ensuring accurate, timely submission and follow-up with payors. You will appeal denied claims and manage difficult accounts deemed unpayable, while applying state/federal regulations related to contracts, CPT/HCPCS, ICD, DRG, and HIPAA transactions.

This role requires at least an associate degree (preferred) and healthcare billing experience, with strong proficiency in Microsoft Office and analytic

Qualifications

• Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively.
• Associates degree preferred.
• One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements.
• Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.
• Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, 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.

Responsibilities

• Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.
• Audit denials and payment variances to determine root cause and correction as required.
• Auditing payment variances ensuring appropriate reimbursement.
• Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.
• Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.

Skills

English proficiency

Education

Associates degree preferred

Tools

Microsoft Office Suite

Job description

Insurance and Claims Specialist | Renown HealthMyChartPay BillShop PlansDonateCareersBook AppointmentClerical & Administrative Support# Insurance and Claims SpecialistRequisition ID: 190549Full Time - Eligible for BenefitsDay8am-4:30pm* $20.17 - $26.04Apply NowThe posted pay range represents the long-term earning opportunity for the position, while starting pay is based on the experience, skills, and qualifications each candidate brings to the role. **Purpose:**The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.## Nature and ScopeThe Insurance and Claims Specialist is responsible for:• Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.• Audit denials and payment variances to determine root cause and correction as required.• Auditing payment variances ensuring appropriate reimbursement.• Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.• Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.• Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to achieve the overall goals of Renown Health.• Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.This position is required to operate within policy and procedural guidelines that will ensure accurate accounts receivable reporting and is compliant with policy and procedural guidelines consistent with Renown Health goals and objectives.This position does not provide patient care## Minimum QualificationsRequirements - Required and/or Preferred| **Name** | **Description** || --- | --- || Education: | Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively. Associates degree preferred. || Experience: | One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience. || License(s): | None || Certification(s): | None || Computer / Typing: | Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, 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. |### DisclaimerThe 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.## Total RewardsRenown 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 Total 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 career with us.### Education Assistance### Paid Time Off### 401(k) Company Match### Flexible Work Environment## CompensationAt Renown Health, we are committed to fair, transparent, and market-competitive compensation practices. Compensation decisions are based on a variety of factors, including relevant experience, qualifications, education, certifications, internal equity, and market considerations. When hiring, our goal is to place candidates appropriately within the pay structure based on the skills, experience, and qualifications they bring to the role, while maintaining consistency with our compensation philosophy and internal equity practices. The full pay range reflects the long-term earning opportunity associated with the position. Employees may also have opportunities for future compensation growth through professional development, expanded responsibilities, strong performance, and career advancement.## About Renown HealthRenown Health is Nevada’s first and only integrated academic health system. Serving northern Nevada, Lake Tahoe and northeast California with a diverse set of specialties and over 8,000 employees, Renown has fostered a longstanding culture of excellence, determination and innovation. Our organization includes a Level II trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and an urgent care network.**Join Our Team Today!**## Academic Health System Information for Provider CandidatesRenown Health and the University of Nevada, Reno School of Medicine (UNR Med) are affiliate partners in Nevada's first and only 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.