Sr Insurance and Claims Specialist

Renown Health - Reno, NV

Full-time - Mid Level

Remote - Reno, NV

Ambulatory Health Care Services

About the position

The Senior Insurance and Claims Specialist is responsible for ensuring compliant billing and system operations to facilitate timely and accurate claim submissions while preventing denials according to regulatory and payor requirements. This role focuses on optimizing systems for accurate claim submissions, managing appeals for denials, and collaborating with various departments to resolve billing issues and implement necessary system changes.

Responsibilities

• Optimize systems to ensure accurate claim submission and follow-up for timely reimbursement.
• Complete detailed appeals of denials or payment variances to payors, incorporating contract terms and clinical or regulatory justifications.
• Recommend system changes to aid in the prevention of claim denials.
• Collaborate with the Renown Contracting Department or payor representatives to resolve billing issues due to changes affecting healthcare claims.
• Assist with testing and troubleshooting systems for payor or regulatory changes.
• Maintain expertise in payor, HIPAA, and other regulatory changes affecting healthcare billing.
• Work with Operations Analysts and IT to improve business systems based on payor or regulatory changes.
• Act as a resource for staff on edit and denial/rejection resolution.
• Identify trends in payor non-compliance and inform management if issues cannot be resolved with payors.
• Demonstrate thorough knowledge of all department functions, processes, and procedures.

Requirements

• Must have working-level knowledge of the English language, including reading, writing, and speaking English.
• Associates Degree preferred.
• Three years of healthcare billing office experience with extensive knowledge of healthcare billing, government, and third-party payor requirements.
• Coding Certification preferred for Professional Billing.
• Proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word.

Nice-to-haves

• Experience with online learning requirements for job-specific competencies.
• Ability to access online forms and policies.

Benefits

• Eligible for benefits including health insurance, paid holidays, and professional development opportunities.