Billing and Claims Analyst / FT

Children's Nebraska•Omaha, NE

About The Position

The Billing and Claims Analyst analyzes professional and/or technical claim errors, rejections, and billing requirements to identify issues that delay claim submission and processing. The analyst works with IT and Central Billing Office leadership to improve claims production, reduce rejections, increase first-pass yields, and make electronic and paper claims workflows more efficient. The role also supports daily billing and claim editing to ensure claims are accounted for and billed successfully to insurers and patients. The analyst reviews claim reports and payer requirements, resolves assigned claim errors and account holds, assists with claim backlogs, supports Billing Specialists, and reconciles claim reports across internal systems, clearinghouses, and third-party vendors. The position maintains documentation of findings and recommendations, identifies trends and opportunities for system and workflow improvements, and stays current with payer requirements and applicable billing regulations, including 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.
Knowledge of hospital and professional billing, collection, and reimbursement requirements and standard practices.
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; the position deals directly with the public daily.
Strong organizational skills, a pleasant attitude, and the ability to work effectively with others.
Organized, self-motivated, and able to work independently without direct supervision.

Responsibilities

Analyze electronic and paper claims and rejections to identify potential issues delaying claim production and opportunities to improve workflows and processes.
Review claims daily or through reports to ensure payer-specific billing requirements are met.
Monitor clearinghouse and system rejections, identify opportunities for system enhancements or fixes, and help prevent recurring rejections.
Assist with claim and rejection backlogs by entering items into the system, routing them to the appropriate area, and requesting additional information when needed.
Ensure late charges are filed according to payer and timely filing guidelines.
Correct assigned claim errors within established timelines and resolve billing or claim holds on accounts.
Assist Billing Specialists by answering inquiries, reviewing account issues, and providing account updates.
Reconcile daily claim trackers and third-party vendor claim reports against system reports, addressing discrepancies promptly.
Identify coverage needs through monthly paper claim reports and refer them to the coverage committee; participate in monthly coverage meetings.
Identify billing edit and rejection trends, review findings with a supervisor when necessary, and submit IT tickets for system improvements.
Maintain detailed and organized documentation of findings and recommendations.
Collaborate with Central Billing Office leadership and IT to improve claim 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.
Keep current on payer requirements through workshops, newsletters, websites, and other electronic tools.
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.