Nebraska Medicine · 8 hours ago
Reimbursement Appeals Sr Associate - PES Drug Assistance
Omaha Metropolitan Area
Full-time
Hybrid
Mid Level
3+ years expNebraska Medicine is committed to providing serious medicine and extraordinary care. They are seeking a Reimbursement Appeals Sr Associate to provide expertise in third party reimbursement and optimize hospital revenue by handling insurance claim denials and ensuring proper reimbursement through a standardized appeal process.
EducationHealth Care
Responsibilities
Provide expertise in routine third party reimbursement
Responsible for maintaining up to date patient account records
Responds to insurance and patient inquiries, whether verbal or written
Handles insurance claim denials, underpayments and resubmission of claims
Optimizes hospital revenue by researching, auditing, identifying trends and resolving possible claim denials through a standardized appeal process
Analyzes payments and payment accuracy comparing billed charges to payment and expected reimbursement for commercial, invoice and governmental payers
Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection
Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement
Reviews, research and appeal partially denied claims for reconsideration
Focus on working complex denials across multiple payers and/or specialties
Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice
Qualification
Required
Minimum of three years experience healthcare compliance experience with hospital or physician revenue cycle processes required
High school education or equivalent required. Associate's degree in business administration, healthcare or related field OR equivalent combination of education/experience combined (one year of education equals one year of experience required)
Knowledge of hospital and/or professional revenue cycle processes required
Ability to work with diverse customer base through effective verbal and written communication required
Multi-tasking and problem solving abilities required
Knowledge of computer based programs including Microsoft Word and Excel required
Strong verbal and written communication skills required
Strong organizational skills with aptitude for detail oriented work required
Ability to type a minimum of 45 words per minute with 95% accuracy required
Preferred
Prior experience with both hospital and physician revenue cycle with billing and Epic systems
Certification through hospital or professional revenue cycle organization preferred
Membership in hospital or professional revenue cycle organization preferred
Company
Nebraska Medicine
Nebraska Medicine is the most esteemed academic health system in the region, consisting of 809 licensed beds at its two hospitals, more than
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
James Linder MD
Chief Executive Officer
Stephanie Daubert
Chief Financial Officer
Recent News
2026-01-11
2025-06-24
2025-05-17
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