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Revenue Specialist Sr

Company: Renown Health
Location: Reno
Posted on: September 21, 2019

Job Description:

Position Purpose:

This position is responsible for supporting the Manager and the Director of Finance in the complex cash receipt cycle of Hometown Health revenue for all commercial insurance product lines. Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines. In addition, the Revenue Specialist completes auditing tasks, system improvement processes and revenue training.

Nature and Scope:

The Hometown Healths revenue consists of all commercial product lines of business including but not limited to Individual and family plans, small group and large group clients and administrative revenue for its third-party administrator business including but not limited to large group TPA and our new Independence plan clients.

The position responsibilities include:

-- Strict adherence to all Federal and State regulations and our State of Nevada department of insurance guidelines.

-- Responsible for maintaining new Policy and Procedures along with desk top processes for Revenue Department.

-- Overseas and directs Revenue Team in prioritizing work as business needs change.

-- Responsible for auditing and testing Revenue system upgrades.

-- Front line audit support with Auditors (external and internal) for annual filings.

-- Acts as the informal leader to the Revenue Team when Leadership is unavailable.


  • Performs special projects including but not limited to system implementations as assigned by Leadership.


    -- Effectively develops implements, evaluates and monitors quality as it relates to revenue.

    -- Responsible for auditing Specialist work to ensure all premiums are accurately and timely accounted for. Premium reconciled for new and existing members/group to our billing procedures.

    -- Manages relationships with group administrators/contacts to ensure that payment transactions are completed to timely to avoid termination and disruption of benefit plans.

    -- Demonstrates the ability to manage workload independently as well as leading a team.


    • Performs complex reconciliations with high quality results and is the subject matter expert in reconciling and revenue processes for the Revenue team.
    • Responsible for mentoring, training and on-going training for Revenue Specialists regarding revenue systems, processes and functions.
    • Maintaining regular communication with Leadership, Configuration Analysts and customers.
    • Performing critical thinking and analysis in determining premium as it relates to the appropriate group, benefit package and riders assigned to members.


      -- Maintaining highly developed reconciliation skills with an emphasis on problem solving.


      • Analyzing discrepancies in premium reconciliation to maintain compliance with policies, procedures and the guidelines under State and Federal insurance regulations.
      • Audits overdue accounts and assists Specialist with collection within 60 days.


        -- Maintaining great customer service skills.

        -- Assists Configuration Analyst with Broker Commission and Provider Recovery process.

        -- Discussing confidential information in a professional manner that is in compliance with HIPPA regulations.

        -- Performing other revenue-related duties as assigned

        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. Bachelors degree from an accredited college or university. (Equivalent experience may substitute for education on a two year experience to one year education basis).

        Experience:

        Four years of business office experience required. Experience in an insurance or financial setting preferred. Experience in managed care, billing and/or collections preferred.

        License(s):

        None

        Certification(s):

        None

        Computer / Typing:

        Must be proficient with Microsoft Office Suite, including Outlook, Excel and Word. Must have the ability to use the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Also requires advanced in depth expertise in Excel including but not limited to formulas. Typing 45+ WPM adjusted for errors.

Keywords: Renown Health, Sparks , Revenue Specialist Sr, Accounting, Auditing , Reno, Nevada

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