"Alerted.org

Schedule: FT, M-F 8am - 5pm (Flexible)

At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most.

A Brief Overview

Analyzes system and payer issues that hinder claim processing and reimbursement. Coordinates with the Manager/Supervisor to research and identify root cause and develop and implement resolution for assigned area (hospital or professional services). Regularly works with payer representatives to address concerns to correct, and when necessary, resubmit affected claims for payment.

Essential Functions

+ Develop and utilize revenue cycle performance metrics, reports, and dashboards to effectively monitor and manage denial and AR trends. Identifies and communicates trends in recurring outstanding AR & denials resulting in need for process improvement or system edits to eliminate future denials for assigned area (hospital or professional services)

+ Works with necessary departments (e.g. IT Resolute, Case management, Authorizations) to drive identified process improvements and needed system edits. Reviews and analyzes insurance denials to determine root causes and implement effective resolution strategies.

+ Collaborate with the denial team and claim analyst to identify trends in payer denials or rejections and escalate these issues Review and track all payer related issues and escalate to payer representative to ensure timely resolution of claim rejection and denials.

+ Monitors/handles impacted claims related to identified payer issues.

+ May need to prepare and submit necessary documentation for resolution Maintain professional relationship with payer representatives to facilitate process improvement. Accomplished through regular communication, managing regularly scheduled payer meetings, sending payer spreadsheets for account escalation, and meeting agendas prior to scheduled meetings. Regularly collaborates with cross-functional teams including finance, billing, coding, and/or compliance departments to ensure accurate and timely revenue cycle operations.

+ Research payer-specific billing and documentation requirements to understand specific reasons for denials and implement measures to prevent future denials, when available.

+ Supports and executes special projects as assigned by the Manager/Supervisor

Education Qualifications

+ Associate's Degree from an accredited college or university in Information Systems, Business, Finance, or related field required. Required

+ Equivalent relevant work experience may be substituted for education. Required

Experience Qualifications

+ Minimum 4 years’ experience working with commercial or government AR and reimbursement processes. Required

Skills and Abilities

+ Knowledge of internal operations to facilitate appropriate revenue cycle management efforts and pricing of our services.

+ 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.

+ Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental programs and regulations.

+ Knowledge of CPT, HCPCS and revenue codes and their effect on reimbursement.

+ Ability to communicate effectively both verbally and in writing.

+ Basic knowledge of Word, Excel, Access and PowerPoint required.

Children’s is an equal opportunity employer, embracing and valuing the unique strengths and differences of people. We cultivate an inclusive environment of respect and trust where we all belong. We do not discriminate based on race, ethnicity, age, gender identity, religion, disability, veteran status, or any other protected characteristic.

**Requisition ID** : 23125