United States onlySchedule: FT, Mon - Fri, Days, Flexible Schedule, Remote after training
At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.
A Brief Overview
Collects outstanding insurance and government payor accounts and unpaid balances via telephone, email, and mail. Verifies the accuracy of all insurance and government payor payments, rebills underpayments, appeals denials and turns them into payments, and ensures accurate payor and government reimbursement on all claims.
Essential Functions
- Follows up on outstanding insurance and government payor claims and charges in follow-up work queues and on various reports by contacting insurance or government carriers and patients for status including processing correspondence.
- Rebills underpayments, appeals denials and turns them into payments, ensures accurate reimbursement from insurance and government payors on all claims.
- Audits accounts for proper payments, coding, balances, adjustments, etc. using appropriate reports and work queues to do so.
- Reviews all secondary claims prior to submission to ensure accuracy of claim and COB registration information. If prior insurance pays more than Medicaid allowable when Medicaid is secondary, handles adjustments according to department procedures.
- Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
- Completes all requests and follow ups with medical records, pharmacy, etc. in order to ensure payments from third party payors.
- Refers adjustments to reverse any discounts/contractual posted incorrectly, per department procedures
- Keeps current on payor requirements though workshops, newsletters, and websites.
- Regular attendance at work is an essential function of the job.
- Perform physical requirements as described in the Physical Requirements section
Education Qualifications
- High School Diploma or GED equivalent Required and
- Associate's Degree in Billing, Coding, Business, Finance, or related filed Preferred
Experience Qualifications
- Minimum 1 year of experience working with commercial or government billing and reimbursement processes or Associate’s degree in Billing, Coding or HIM Required
Skills and Abilities
- Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities
- Knowledge of hospital and professional billing, collection and reimbursement requirements and standard practice.
- Ability to review, interpret and understand managed care contracts and EOB’s with third-party payers to ensure appropriate reimbursement.
- Intermediate computer skills including the use of spreadsheet programs and word processing programs.
- Strong interpersonal skills with attention to detail and ability to organize, interpret, and present data.
- Excellent oral and written communication skills as this position will deal directly with the public daily.
- Ability to perform non-complex arithmetic calculations
Licenses and Certifications
- EPIC - EPIC Certification Preferred
Children’s is an equal opportunity employer, embracing and valuing the unique strengths and differences of people. We cultivate an inclusive environment of respect and trust where we all belong. We do not discriminate based on race, ethnicity, age, gender identity, religion, disability, veteran status, or any other protected characteristic.
