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Children's Nebraska · 5 hours ago

Professional Billing -Insurance Follow-up & Denial Specialist / FT

Omaha, NE

Full-time

Hybrid

Entry Level

1+ years exp

Children's Nebraska is the state’s only full-service pediatric healthcare center dedicated to improving the life of every child through exceptional care. The Insurance Follow-up Specialist is responsible for managing outstanding insurance balances and denials, conducting follow-up activities, and ensuring compliance with billing requirements.

Health CareMedicalNon Profit

Growth Opportunities

Responsibilities

Follow up on insurance or government claims to research and resolve unpaid claim and denials in follow-up work queues by contacting payers and/or patients for status

Responsible for obtaining reimbursement information when payment and remit are both provided via paper

Communicate effectively over the phone and through written correspondence to explain why a balance is outstanding and denied using accurate and supported reasoning based on EOBs, medical records, and payer specific requirements

Resubmit claims with necessary information and medical records when requested by payer through paper or electronic methods to ensure payments from third party payors

Organize open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc

Apply a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices

Accurately documents patient accounts of all actions taken in the system

Responsible for resolving work queues according to the prescribed priority and/or per the direction of management and in accordance with department expectations

Recognize when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels

Anticipate, identify, and communicate potential areas of concern or improvement within the follow-up functions

Assist with escalated issues as necessary as directed by leadership

Keep current on payor requirements though workshops, newsletters, and websites

Complies with Federal and State billing requirements

Also Complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats

Other duties as assigned by leader and organization

Qualification

Healthcare billing knowledgeInsurance reimbursement processesCPTICD codingComputer skillsAttention to detailInterpersonal skillsCritical thinkingOrganizational skills

Required

High School Diploma or GED equivalent

Minimum 1 year of experience working in a healthcare related field, preferably with health insurance billing and reimbursement processes

Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities

Intermediate computer skills including the use of spreadsheet programs and word processing programs

Knowledge of general concepts and practices that relate to hospital or professional billing, collection and reimbursement, the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned functions

Knowledge of medical insurance, CPT and ICD codes

Ability to demonstrate excellent interpersonal skills, demonstrating attention to detail and critical thinking skills within the context of the assigned functions, with a commitment to accuracy

Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations

Ability to perform non-complex arithmetic calculations

Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details

Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility