Reimbursement Appeals Sr Associate

Nebraska Medicine•Omaha, NE

1d•Onsite

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. 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.

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.
Maintain up to date patient account records.
Respond to insurance and patient inquiries, whether verbal or written.
Handle insurance claim denials, underpayments and resubmission of claims.
Optimize hospital revenue by researching, auditing, identifying trends and resolving possible claim denials through a standardized appeal process.
Analyze 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.
Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
Review, research and appeal partially denied claims for reconsideration.
Focus on working complex denials across multiple payers and/or specialties.
Conduct 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.