Qureos Mentor

Renown Health

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 Position Purpose
 
 
 
 The Insurance and Claims Specialist will review and correct claim errors ensuring accurate, timely claim submission and account follow-up to assigned payors and reimbursement on first claim submitted. The Specialist will appeal healthcare claims denied by third-party payors to obtain reimbursement and handle difficult, hard to collect accounts that have been deemed by the insurance company as unpayable. The Specialist will conduct analysis and resolve incorrect reimbursement issues and credit balance resolution with payors. This position is responsible to know all state/federal regulations that relate to contracts and to the appeal process and/or government payor billing and follow-up regulations to include CCI, LCD/NCD and medical necessity rules.
 
 
 
 Nature and Scope
 
 
 
 
 The Insurance And Claims Specialist Is Responsible For
 
 
 
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 Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.
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 Audit denials and payment variances to determine root cause and correction as required.
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 Auditing payment variances ensuring appropriate reimbursement.
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 Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.
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 Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance.
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 Work with leadership and other internal departments to improve processes, increase accuracy, create efficiencies and decrease denials to achieve the overall goals of Renown Health.
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 Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.
 
 
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 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.
 
 
 
 Disclaimer
 
 
 
 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
 
 
 
 Name
 
 
 
 
 Description
 
 
 
 Education:
 
 
 Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.
 
 
 
 Experience
 
 
 
 One year healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. Associate degree or certification in accredited billing certification may be accepted in lieu of years of experience.
 
 
 
 License(s)
 
 
 
 None.
 
 
 
 Certification(s)
 
 
 
 None.
 
 
 
 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.
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Insurance and Claims Specialist

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 Position Purpose
 
 
 
 Under the direction of the Lab Leadership, this position sorts, picks up and transports laboratory specimens and some patient related items within Renown Health System and the community physician offices. This position will be responsible for entering provider practices while building rapport and having direct interaction with office personnel. This position is expected to deliver very good customer service and interact directly with laboratory leadership and escalate client issues, updates, and/or complaints as needed.
 
 
 
 Nature And Scope
 
 
 
 This position is challenged by multi tasking an ongoing variety of customers with concerns and needs which require attention and a timely response.
 
 
 The incumbent will often deal with situations that are extremely sensitive in nature. It is imperative that they be treated with tact, diplomacy, confidentiality and care. This position is responsible for communicating changes in provider practices, and relaying route opportunities to leadership.
 
 
 This position provides pick-up and delivery services for several departments within Renown Health, as well as community provider offices. The incumbent will receive, sort and distribute lab specimens, supplies, mail, various documents and medical reports to such locations. The incumbent may be required to perform other related duties and work overtime.
 
 
 The incumbent must possess the ability to sort, prioritize and organize items to be delivered or picked up on routine delivery routes or as &ldquo;STAT&rdquo; calls. The incumbent must be able to determine if the items are appropriate for transportation and determine the appropriate mode of transportation dependent on temperature and special handling requirements. The incumbent must be able to function autonomously, make appropriate decisions concerning priority of request and understanding when a situation requires escalation to a department leader.
 
 
 Incumbent will be required to operate a motor vehicle and abide by all state laws concerning traffic and safety. Must meet insurance requirements for good driving record. Incumbent must ensure that the vehicle is clean and in safe operating order at all times. Any deficiencies must be reported to a department leader immediately. Must be able to understand layout of the community and use a map of GPS devise to locate non routine locations.
 
 
 Incumbent must demonstrate the desire to promote a caring environment as well as maintain a polite, positive attitude while dealing with customers of all ages, social, cultural and economic backgrounds.
 
 
 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 or bachelors degree preferred.
 
 
 
 Experience
 
 
 
 Applicants with related experience will be given preference. Customer Service Experience preferred.
 
 
 
 License(s)
 
 
 
 Ability to obtain and maintain a valid State of Nevada Drivers license and to pass Renown Health's Department of Motor Vehicles Report criteria.
 
 
 
 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.
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Insurance and Claims Specialist

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