Reimbursement Appeals Sr Associate

Shift:

Reimbursement Appeals Sr Associate
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.

Why Work at Nebraska Medicine?

• Together. Extraordinary. Join a team that values your skills, delivering exceptional care through collaboration.
• Leading Health Network Work with the region's top academic health network, partnering with UNMC to transform lives through education, research, and patient care.
• Diversity and Inclusion We value diverse backgrounds and experiences, reflecting the communities we serve.
• Educational Support Enjoy up to $5,000/year in tuition assistance, a 35% discount at Clarkson College, and career advancement opportunities with covered educational costs.

Duties: Reimbursement Appeals Sr Associate
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.

Required Qualifications: Reimbursement Appeals Sr Associate

• 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.

Preferred Qualifications: Reimbursement Appeals Sr Associate

• 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.