Reimbursement Appeals Sr Associate - PES Drug Assistance

Nebraska Medicine•Omaha, NE

37d•Hybrid

About The Position

Serious Medicine is what we do. Being extraordinary is who we are. Every colleague plays a key role in upholding this promise to our patients and their families. Shift: First Shift (United States of America) Reimbursement Appeals Sr Associate - PES Drug Assistance Provide expertise in routine third party reimbursement. Responsible for maintaining up to date patient account records. Responds to insurance and patient inquiries, whether verbal or written. Handles insurance claim denials, underpayments and resubmission of claims. Optimizes hospital revenue by researching, auditing, identifying trends and resolving possible claim denials through a standardized appeal process. Analyzes payments and payment accuracy comparing billed charges to payment and expected reimbursement for commercial, invoice and governmental payers. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection. Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement. Reviews, research and appeal partially denied claims for reconsideration. Focus on working complex denials across multiple payers and/or specialties. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice. Details Full time - Benefits Eligible (1.0 FTE) Training hours will be 7am-3:30pm for 6-8 weeks Monday-Friday, 8 hours shifts starting between 6:00am - 9:00am This role will be based at our ECCP location in the Mutual of Omaha building in Omaha, Nebraska near 33rd and Farnam, while also having the opportunity to transition to a hybrid or remote schedule after successfully completing training. The training period is for 6 months, and you must be located in either Nebraska or Iowa. Nebraska Medicine is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, marital status, sex, age, national origin, disability, genetic information, sexual orientation, gender identity and protected veterans’ status. Nebraska Medicine includes two hospitals, the state's largest and highest rated Nebraska Medical Center and Bellevue Medical Center, along with more than 70 primary care and specialty clinics. Nebraska Medicine and our research and education partner, the University of Nebraska Medical Center (UNMC), share the same mission: to lead the world in transforming lives to create a healthy future for all individuals and communities through premier educational programs, innovative research and extraordinary patient care. Every colleague plays a key role in upholding our promise of “Serious Medicine, Extraordinary Care” to our patients and their families. Working with Nebraska Medicine means committing to meaningful, impactful work that will elevate the success of your fellow colleagues and will help our patients and their families feel comfortable, confident and cared for. Use this tool to search for jobs with Nebraska Medicine. Opportunities include full-time, part-time and casual positions in patient care, nursing, nursing support, allied health, diagnostics, administration, customer service, facilities, IT and more. If you are seeking Physician Opportunities, please visit NebraskaMed.com/Careers/Physician-opportunities For opportunities in Food and Environmental Services, please visit NebraskaMed.com/Careers/Food-environmental-services The option to create an automated alert of new job postings is available to candidates. You must create/sign in to our external career site by clicking “Sign In” in the top right corner of the page. If you have not created a sign in yet, please follow the directions on the page. A confirmation email will be sent that you must confirm before any job alerts will be sent. Job alerts are sent daily when a new job requisition is posted that meets your job alert criteria.

Requirements

Minimum of three years experience healthcare compliance experience with hospital or physician revenue cycle processes required.
High school education or equivalent required.
Associate’s degree in business administration, healthcare or related field OR equivalent combination of education/experience combined (one year of education equals one year of experience required).
Knowledge of hospital and/or professional revenue cycle processes required.
Ability to work with diverse customer base through effective verbal and written communication required.
Multi-tasking and problem solving abilities required.
Knowledge of computer based programs including Microsoft Word and Excel required.
Strong verbal and written communication skills required.
Strong organizational skills with aptitude for detail oriented work required.
Ability to type a minimum of 45 words per minute with 95% accuracy required.

Nice To Haves

Prior experience with both hospital and physician revenue cycle with billing and Epic systems.
Certification through hospital or professional revenue cycle organization preferred.
Membership in hospital or professional revenue cycle organization preferred.

Responsibilities

Provide expertise in routine third party reimbursement.
Responsible for maintaining up to date patient account records.
Responds to insurance and patient inquiries, whether verbal or written.
Handles insurance claim denials, underpayments and resubmission of claims.
Optimizes hospital revenue by researching, auditing, identifying trends and resolving possible claim denials through a standardized appeal process.
Analyzes payments and payment accuracy comparing billed charges to payment and expected reimbursement for commercial, invoice and governmental payers.
Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
Reviews, research and appeal partially denied claims for reconsideration.
Focus on working complex denials across multiple payers and/or specialties.
Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice.