Insurance and Claims Representative

Position Purpose:

The Insurance and Claims Representative is accountable for the billing and collections of Renown healthcare claims, ensuring timely and accurate claim submission, maximizing reimbursement for those services rendered in order to maintain a consistent cash flow.    

Nature and Scope:

The Insurance and Claims Representative is responsible for:

·         Accuracy and completeness of patient accounts for billing and follow-up of healthcare claims to ensure timely claim adjudication in accordance with Renown policies and healthcare payor rules and regulations. 

·         Review, evaluation and submission of additional documentation to payors that do not accept electronic claims or require special handling. 

·         Conducts prompt follow up with insurance companies by phone or reviewing online payor portals, performing necessary follow up action to obtain payment.    

·         Documenting the patient account and completing inquiries from patients, insurance companies, internal departments, attorneys and 3rd party payers in a timely manner while providing excellent customer service. 

·         Assisting with review and resolution of denials, credit balances or underpayments as assigned.

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.

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.

Experience:

Must have a minimum of six months applicable computer application experience in a business setting.  Previous healthcare experience is preferred.

License(s):

None.

Certification(s):

None.

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.