Billing and Claims Analyst / FT

Children's Hospital & Medical Center•Omaha, NE

About The Position

The Billing and Claims Analyst analyzes professional and/or technical claims, errors, and rejections to identify issues that delay claim submission and processing. The role collaborates with IT and Central Billing Office (CBO) leadership to improve claims production, reduce rejections, increase first-pass yields, and improve efficiency for electronic and paper claims. The analyst also assists with higher-level daily billing and editing to ensure claims are accounted for and billed successfully to insurance companies and patients. This position reviews claims and payer requirements, corrects claim errors and account holds, supports Billing Specialists, reconciles claim and vendor reports, and documents findings and recommendations. The analyst keeps current on payer requirements and applicable government regulations, and performs work in accordance with Central Billing Office policies, Federal and State billing requirements, HIPAA, and EDI transaction formats.

Requirements

Associate's degree in billing, coding, business, finance, or a related field, or equivalent relevant work experience in place of education.
At least 4 years of experience working with professional and/or hospital insurance billing and claims.
Organized, self-motivated, and able to work independently without direct supervision.
Knowledge of hospital and professional billing, collection, and reimbursement requirements and standard practice.
Ability to review, interpret, and understand managed care contracts with third-party payors.
Intermediate computer skills, including spreadsheet and word processing programs.
Strong interpersonal skills, attention to detail, and ability to organize, interpret, and present data.
Excellent oral and written communication skills, including the ability to deal directly with the public daily.
Excellent interpersonal communication and organizational skills, a pleasant attitude, and the ability to work effectively with others.

Responsibilities

Analyze electronic and paper claims and rejections to identify issues that delay claim production.
Identify opportunities to optimize workflows and processes and enhance the patient and employee experience.
Analyze claims and reports to ensure payer-specific billing requirements are met.
Monitor clearinghouse and system rejections to identify system enhancements or fixes that could improve efficiency and prevent recurring rejections.
Assist with processing claims and rejections during backlogs, including entering items into the system, routing them to the appropriate bucket, and directing them for resolution.
Ensure late charges are filed according to payer and timely-filing guidelines.
Request additional information from appropriate staff when needed.
Correct assigned claim errors in the system or dashboard within established timelines and resolve bill or claim holds on accounts.
Assist Billing Specialists by responding to inquiries, reviewing account issues, and providing account updates.
Reconcile daily claim trackers and third-party vendor claim reports against system reports, and address reconciling items promptly.
Identify coverages through monthly paper claim reports and refer them to the coverage committee for coverage builds.
Participate in monthly coverage meetings to discuss new payer requests and concerns.
Identify billing edits and rejection trends, review findings with the supervisor when necessary, and submit tickets to IT for system improvements.
Maintain detailed, organized documentation of findings and recommendations.
Collaborate with CBO leadership and IT to improve claims production and first-pass yields.
Seek improvements to systems, workflows, and processes to reduce manual intervention and paper claims.
File claims according to Central Billing Office policies and procedures.
Maintain a thorough understanding of clearinghouse and EHR systems to support accurate claim edits.
Stay current on payer requirements using workshops, newsletters, websites, and other electronic tools, including Experian.
Review government and payer manuals, websites, and communications for existing and new claim requirements.
Comply with Federal and State billing requirements, HIPAA, and EDI transaction formats.
Perform other duties as assigned by the leader and organization.