Healthcare Claims Specialist

2 weeks ago


Reno, Nevada, United States Renown Health Full time
Job Summary

The Insurance and Claims Specialist will play a critical role in ensuring accurate and timely claim submissions, as well as resolving reimbursement issues and credit balances with payors. This position requires a strong understanding of healthcare billing regulations, including CCI, LCD/NCD, and medical necessity rules.

Key Responsibilities
  • Review and correct claim errors to ensure accurate reimbursement.
  • Audit denials and payment variances to determine root cause and correction.
  • Provide in-depth contract knowledge to ensure maximum reimbursement of healthcare claims.
  • Resolve credit balances by reviewing payments, adjustments, or transfers.
  • Work with leadership and other internal departments to improve processes and decrease denials.
Requirements
  • Two years of healthcare billing office experience with extensive knowledge of healthcare billing regulations.
  • Associates degree preferred.
  • Proficiency with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word.

This position is responsible for operating within policy and procedural guidelines to ensure accurate accounts receivable reporting and compliance with Renown Health goals and objectives.



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