Insurance and Claims Specialist

  • Requisition ID: 179280
  • Department: 100621 Professional Billing Services
  • Schedule: Full Time - Eligible for Benefits
  • Shift: Day
  • Category: Administrative Support Workers

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:


• Work assigned Work Queues to correct errors, ensuring accurate claims and reimbursement on first claim submission.

• Audit denials and payment variances to determine root cause and correction as required. 

• Auditing payment variances ensuring appropriate reimbursement.

• Provide specific and in depth contract knowledge to ensure maximum reimbursement of healthcare claims.

• Resolve credit balances by reviewing payments, adjustments or transfers correcting the patient account to reflect an accurate account receivable balance. 

• 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.

• Maintain a current knowledge of CPT/HCPCS, ICD, DRG, HCFA forms, ability to manipulate and analyze 837 and all other HIPAA transaction sets.


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.  





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




Must have working-level knowledge of the English language, including reading, writing and speaking English. Associates degree preferred.


Two years healthcare billing office experience with extensive knowledge of healthcare billing, government and third party payor requirements. One year employment with Renown or/and Certification in CPB or other accredited billing certification will be accepted in lieu of years of experience.





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.




Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.

With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.

  • Icon- Edu Assistance@1x

    Education Assistance

  • Icon - PTO@1x

    Paid Time Off

  • Icon - 401@1x

    401(k) Company Match

  • Icon - Flexible Env@1x

    Flexibile Work Environment