Sr Insurance and Claims Specialist

Renown Health; Reno (NV); On-site; USD 60,000 - 88,000; Full time

Job summary

Renown Health is seeking a Senior Insurance and Claims Specialist to ensure compliant billing and timely claim submission, with a focus on reducing denials and improving payment turnaround.

The role involves optimizing submission systems, handling denials appeals, and staying current with HIPAA and regulatory requirements. The position does not provide patient care and collaborates with contracting, IT, and operations teams to resolve issues.

Qualifications

• Three years healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements.
• Associates Degree Preferred.
• Coding Certification Preferred for Professional Billing.
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).

Responsibilities

• Optimize the system to ensure accurate claim submission and timely reimbursement per payor/regulatory guidelines.
• Complete detailed appeal of denials or payment variances to payor with justification.
• Recommend system changes to prevent denials and improve clean claim submission.
• Collaborate with Renown Contracting Department or payor representatives to resolve billing issues.
• Assist with testing/troubleshooting system changes related to payor or regulatory updates.
• Maintain expertise on all payor, HIPAA and regulatory changes affecting billing.
• Work with Operations Analysts and IT to implement system improvements.
• Serve as a resource for staff on edit and denial/rejection resolution.
• Identify trends in payor non-compliance and inform management if unresolved.

Skills

Healthcare billing knowledge

Microsoft Office

Outlook

PowerPoint

Excel

Word

Education

Associate degree preferred

Job description

Position Purpose:

The Senior Insurance and Claims Specialist is responsible for compliant billing 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.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work 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

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English.Associates Degree Preferred.

Experience:

Three years healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements.

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.