Insurance and Government Reimbursement Specialist

Children's Hospital (Omaha)
Omaha, Nebraska
Not Specified
Feb 17, 2017
Feb 20, 2017
Job Type
Not Specified
Career Level
Not Specified
Job DescriptionJust like the children we serve, Children's is growing quickly and hiringInsurance and Government Reimbursement Specialistsfor our Central Billing office. In this role you will collect outstanding accounts and unpaid balances via telephone, email, and mail. Verify the accuracy of all payments, rebills underpayments, appeals denials and turns them into payments, and ensure accurate reimbursement on all claims. Essential Functions/Competencies % of Time 45% 1. Follows up on outstanding 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. 20% 2. Rebills underpayments, appeals denials and turns them into payments, ensures accurate reimbursement on all claims. 3. Audits accounts for proper payments, coding, balances, adjustments, etc. using appropriate reports and work queues to do so. 10% 4. 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. 5% 5. Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats. 5% 6. Completes all requests and follow ups with medical records, pharmacy, etc. in order to ensure payments from third party payors. 5% 7. Refers adjustments to reverse any discounts/contractual posted incorrectly, per department procedures 5% 8. 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 SECONDARY FUNCTIONS/COMPETENCIES 5% 9. Performs other duties as assigned 100% KNOWLEDGE, 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 EOBs 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. EDUCATION AND EXPERIENCE:High School diploma or GED equivalent required. Minimum two years of experience working with commercial or government billing and reimbursement processes or Associates degree in Billing, Coding or HIM required. Associates degree in Billing, Coding, Business, Finance, or related field preferred. Glassdoor

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