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Reinsurance Coordination Specialist
1 month ago
Renown Regional Medical Center Reinsurance Coordination Specialist Reno, Nevada Apply Now
SCHEDULE: Full Time - Day 8:00am to 5:00pm
SALARY: Actual salary offered may vary based on multiple factors, including but not limited to, an individual's location and their knowledge, skills, and experience as well as internal equity.
TO APPLY:
Apply Here
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SUMMARY: Under the direction of the Manager of Claims, the Reinsurance Coordination Specialist is responsible for the processing, auditing, testing, and reporting of reinsurance activity for Hometown Health and its respective third-party partners.
MINIMUM/PREFERRED REQUIREMENTS:
Must have working-level knowledge of the English language, including reading, writing, and speaking English.
Two-year degree from an accredited college or university or equivalent experience in a healthcare-related field is required.
Three years of experience in claims or medical billing, managed care systems, including HMO, PPO, Dental, TPA, Medicare products, which included processing of coordination of benefits and subrogation.
Knowledge of CPT, ICD9, HCPCS, ASA, ADA, and DRG coding is required.
Familiarity with medical terminology.
Ability to understand the technical aspects of managed care systems and interpret health plan benefits and coverage.
Ability to interpret provider contract provisions.
Knowledge of state and federal regulations.
JOB RESPONSIBILITIES/DUTIES: The Reinsurance Coordination Specialist is responsible for:
Running reports for respective groups and their specific reinsurance policy period.
Providing direct and secure electronic correspondence with third-party partners.
Coordinating complex reinsurance claims with Hometown Health Claims department and third-party partners.
Coordinating the appeal process on denied reinsurance claims.
Clear reporting and communication to senior leadership.
Coordinating audit functions for third-party partners and accrediting agencies as required.
Acting as a liaison to resolve billing disputes, obtain appropriate documentation, and achieve resolution. Identifying and reporting aberrations to management as appropriate.
This position does not provide patient care.
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