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Schedule: FT, 8-4:30

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

Performs patient account receivable functions including claim submission, follow-up and collection in a timely and accurate manner.

Essential Functions

+ • Validate the accuracy of all billed charges and of all new patient reimbursement files including complete patient, responsible party and insurance information billing edit lists and noting any necessary changes, fixes or additions. • Review assigned tasks, emails, and work queues daily and take steps complete the tasks assigned. • Recognize, summarize, and communicate potential reimbursement issues with the Billing Supervisor. • Mail all insurance claims according to specific contract/payer requirements. Update EDI rejects to ensure successful submission of electronic claims. When applicable, submit claims via state and/or insurance portal. • Complete claim follow-up via portal or phone call on claims 30 days or older outstanding from the submission date. • Review Account Receivable payor aging accounts and perform follow-up as required for outstanding aged invoices. • Detect any other issues that could affect payment; works with appropriate staff members in other departments to ensure claims are ready for billing • Review updated insurance information, update patient insurance tab, and rebill invoices accordingly. • Perform claim appeal functions upon receipt of EOBs. Follows-up on outstanding claims with insurance carrier and patient for status including processing correspondence, resubmitted denied claims, claims that are inaccurately processed, reconsiderations, and appeals. • Process all account refunds within 30 days of identification. • Provide zero pay EOBs or other unposted EOBs to cash posting for processing. • Review posted adjustments to ensure accuracy. • Process adjustments/write offs accurately for uncollectable accounts within the dollar amount specified. Submit adjustments/write off requests for balances above specified threshold to the Billing Supervisor and/or Manager. • Forward issues for held accounts, including CMN or PAR hold to the correct team for review. • Remain knowledgeable of third-party payer contracts, federal and state medical coverage programs and requirements as well as being knowledgeable on HIPAA regulations and guidelines. • Comply with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.

+ • Escalate accounts as necessary • Answer billing inquiries from parents and third-party payers in a professional manner that demonstrates and supports good relations between Children’s Home Healthcare, the contracted providers, and the community. • Answer phone calls from patient families and other departments with billing questions

+ Regular attendance at work is an essential function of the job.

+ Perform physical requirements as described in the Physical Requirements section

+ Serves as backup to the receptionist.

Education Qualifications

+ High School Diploma or GED Required

+ Associate's Degree in Business, Finance, or related field Preferred

Experience Qualifications

+ 3-years experience working with insurance and/or revenue cycle related processes Required and

+ Experience working with ICD-10, CPT and HCPC coding Preferred and

+ Experience with universal billing forms such as UB04 and HCFA 1500 Preferred

Skills and Abilities

+ Knowledge of the current healthcare climate, including current coding practices in regards to billing and processing of Explanation Of Benefit, managed care contracts, HIPAA standards and governmental program regulations.

+ Ability to communicate effectively both verbally and in writing.

+ The ability to use computers and 10 key adding machine, fax machine and copier.

+ Must have the ability to work independently to effectively and efficiently perform assigned duties.

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** : 23297