Insurance and Claims Specialist

$39,853 - $55,786/Yr

Renown Health - Reno, NV

Full-time - Entry Level

Reno, NV

Ambulatory Health Care Services

About the position

The Insurance and Claims Specialist at Renown Health is responsible for reviewing and correcting claim errors to ensure accurate and timely claim submissions. This role involves appealing denied healthcare claims, resolving reimbursement issues, and maintaining compliance with state and federal regulations related to billing and appeals. The Specialist will work closely with leadership and other departments to improve processes and reduce claim denials, ultimately aiming for maximum reimbursement for healthcare claims.

Responsibilities

• Review and correct claim errors to ensure accurate claim submissions.
• Appeal healthcare claims denied by third-party payors to obtain reimbursement.
• Conduct analysis and resolve incorrect reimbursement issues and credit balance resolutions with payors.
• Audit denials and payment variances to determine root causes and necessary corrections.
• Provide in-depth contract knowledge to ensure maximum reimbursement of healthcare claims.
• Resolve credit balances by reviewing payments, adjustments, or transfers to correct patient accounts.
• Collaborate with leadership and internal departments to improve processes and decrease denials.
• Maintain current knowledge of CPT/HCPCS, ICD, DRG, and HIPAA transaction sets.

Requirements

• Associate's degree preferred.
• Two years of healthcare billing office experience with extensive knowledge of healthcare billing and payor requirements.
• Proficiency in Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word.
• Ability to complete online learning requirements and access online forms and policies.

Nice-to-haves

• Certification in CPB or other accredited billing certification may substitute for experience.

Benefits

• Full-time position eligible for benefits.
• Day shift from 8 AM to 5 PM.