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.
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