Sr Insurance and Claims Specialist

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.

License(s):

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.