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Claims Resolution Specialist - Full Time

Universal Health Services

Job Code:
Universal Health Services
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Job Details

Claims Resolution Specialist - Full Time

Job Code:  224825
Facility: Prominence Health Plan
Location: RENO, NV US Western
Region: Western
Travel Involved: None
Job Type: Full Time
Job Level: 
Minimum Education Required: High School or equivalent 
Skills: Health Care -> Accounting/Billing
Category: Healthcare - Rehabilitation,Office/Clerical,Support
FTE: 1.0
Position Summary:

Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected health care management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 65,000 employees. The UHS business strategy is to build or purchase health care properties in rapidly growing markets and create a strong franchise based on exceptional service and effective cost control. Our success comes from a responsive management style and a service philosophy based on integrity, competence and compassion.

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies.
In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.
We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary: The Claims Resolution Specialist acts as a liaison between members, providers and employer groups in resolving verbal and written service issues and disputes.


Regulatory Requirements:

• High School Diploma. Associates degree preferred.
• Thorough knowledge of CPT, ICD-9 and CDT coding and medical terminology. Minimum 2 years’ experience in health care claims processing, preferably in a managed care environment, including customer service experience.
• Minimum of three years medical claims processing and one year of customer service experience. Ability to plan, organize, maintain priorities and schedules, as well as assure that deadlines are met.
• Certified coder preferred CCA or CCS designation or must be able to obtain certification within one year of employment.

Language Skills:

• Excellent verbal and written communication skills.

• Ability to interpret health plan benefits and provider contracts.
• Must be able to deal with difficult customers in a professional manner.
• Ability to interpret and apply established policies and procedures.
• Excellent computer skills which must include working knowledge of Microsoft Office Suite.
• Must be a team player and have the ability to work independently with little supervision.

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