Insurance Follow-up & Denial Specialist / Revenue Cycle

Children's Nebraska•Omaha, NE

11h

About The Position

The Insurance Follow-up Specialist corresponds with commercial and government insurance payers to address and resolve outstanding insurance balances and denials in accordance with established standards, guidelines, and requirements. The role conducts follow-up activities through phone calls, online processing, fax, and written correspondence, using work queues to organize tasks efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons, and resolving issues through written appeals. The specialist explains outstanding balances and denials using accurate, supported reasoning based on explanations of benefits, medical records, and payer-specific requirements. The position documents account actions, resubmits claims with requested information, and organizes accounts by denial type or payer to resolve issues efficiently. The role follows department priorities, escalates issues when needed, identifies potential concerns or improvements, and keeps current on payer requirements and applicable billing, privacy, and electronic data standards. Children’s Nebraska describes its culture as People First, emphasizing joy, belonging, wellbeing, learning, and growth. The organization’s mission is to improve the life of every child through exceptional care, advocacy, research, and education.

Requirements

High school diploma or GED equivalent.
At least one year of experience working in a healthcare-related field; health insurance billing and reimbursement experience is preferred.
Ability to work independently, stay organized, and remain self-motivated.
Intermediate computer skills, including spreadsheet and word processing programs.
Knowledge of hospital or professional billing, collections, reimbursement, healthcare practices, and applicable policies, standards, procedures, and practices.
Knowledge of medical insurance and CPT and ICD codes.
Excellent interpersonal skills, attention to detail, critical thinking, and commitment to accuracy.
Ability to troubleshoot and adapt moderately complex oral or written instructions and guidelines to varied situations.
Ability to perform non-complex arithmetic calculations.
Ability to understand and apply government and commercial insurance reimbursement terms, contractual and other adjustments, and remittance advice details.
Ability to keep abreast of trends, developments, and changing regulatory requirements relevant to assigned responsibilities.

Nice To Haves

Associate’s degree from an accredited college or university in Business, Finance, or a related field.
Experience with health insurance billing and reimbursement processes.

Responsibilities

Follow up on insurance or government claims in work queues to research and resolve unpaid claims and denials by contacting payers and/or patients for status.
Obtain reimbursement information when payment and remittance are both provided on paper.
Communicate by phone and in writing to explain outstanding balances and denials using supported reasoning based on EOBs, medical records, and payer requirements.
Resubmit claims, with necessary information and medical records, through paper or electronic methods when requested by payers.
Organize open accounts by denial type or payer and address them in bulk using phone calls, spreadsheets, or online payer portals.
Interpret explanations of benefits and remittance advices.
Accurately document all actions taken in patient accounts.
Resolve work queues according to prescribed priorities, management direction, and department expectations.
Recognize when additional assistance is needed and escalate appropriately and promptly through established channels.
Identify and communicate potential concerns or improvements in follow-up functions, and assist with escalated issues as directed by leadership.
Keep current on payer requirements through workshops, newsletters, and websites.
Comply with federal and state billing requirements, HIPAA, and EDI transaction formats.
Perform other duties as assigned by the leader and organization.