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Follow-up Specialist

Boys Town National Research Hospital Omaha, NE
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GENERAL SUMMARY

Boys Town is looking for a talented, organized, and detailed individual for the role of Follow UpSpecialist. Under the direction of the Insurance Follow up Supervisor, you will be responsible for reducing and managing the A/R by reviewing and resolving unpaid claims related to clinical/facility charges. Daily workflow of denials and no response from insurance payers for HCFA/UBO4, chart notes/faxes and appeals worked in a timely manner to ensure claims are processed according to payer fee schedules and timely filing appeal guidelines are followed. Resolve insurance billing issues to reduce account receivable days outstanding, increase cash flow and reduce potential bad debt. Communicate and collaborate with leadership to ensure third party payer issues are resolved in a timely manner. Accurately resubmit claims for payment to prevent and reduce further rejections/denials. Actively communicate common denials/rejections to help streamline and improve claims submission. Appropriately monitor assigned accounts to ensure accurate and timely payment is received, while contributing to the overall health of Boys Town National Research Hospital (BTNRH) A/R. To be successful in this role, you will need to possess strong communication skills and enjoy a fast-paced work environment.

MAJOR RESPONSIBILITIES & DUTIES

  • Works assigned payer denials and claims not responded to in order to ensure proper handling and maintain appropriate follow through workflows for claim resolution. When necessary, uses creative approaches and information gathered from contacting payers when new denials are presented to seek reimbursement. Determines reasons for denials and recommends the appropriate action to prevent future denials when possible.
  • Determines and processes account adjustment transactions in accordance with department procedures. Completes transactions using the appropriate adjustment code allowing for account level and reporting integrity.
  • Identifies and works with department members and management to resolve coding, billing, denial, and reimbursement trends along with identifying other revenue cycle problems.
  • Maintains up to date knowledge of BTNRH payer contracts/fee schedules to fully understand correctness of payer response and allowances received on remittance advices.
  • Maintains an in-depth understanding and expertise of assigned payer(s) billing requirements, including 837 I and 837 P loops and segments according to 5010 rules, to ensure timely and accurate response/payment, is received from third party payers.
  • Maintains current knowledge of all HCFA 1500 & UB-04 electronic and paper claim elements and requirements, insurance ANSII codes and relating BTNRH registration processes that affect the accuracy of billing.
  • Achieves or exceed goals and objectives set for position and/or department, maintaining productivity and quality standards, while formulating an action plan when necessary to improve personal performance.
  • Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.
  • Knowledge, Skills and Abilities Required
    • Ability to apply moderate analytic skills to review data and trends, as well as to organize workload according to established priorities.
    • Ability to maintain a positive, friendly and professional attitude at all times with patients, as well as internal and external customers.
    • Ability to perform arithmetic calculations and be familiar with the use of Microsoft Office Applications (Excel, Word, Outlook, etc.) while typing consistently at a minimum of 40 wpm.
    • Ability to treat all information gained with strict confidentiality.
    • Ability to operate standard office machines and equipment such as a multi-line telephone, calculator, photocopier, desktop computer.
    • Ability to communicate concisely, both orally and in writing, with a wide variety of people, to include managers and coordinators.
    • Ability to work independently with limited supervision, as well as to function as a team player, taking initiative and demonstrating the highest professional and ethical standards to represent the Patient Financial Services department.
    • Working knowledge of health care coding systems (procedural, diagnosis, modifier, remittance and others).
    • Understanding and ability to utilize various electronic, web based and manual coding and payer resources.
    • General understanding and knowledge of Center for Medicare and Medicaid Systems (CMS) billing and coding requirements and compliance expectations.
    • Working knowledge of government and commercial health plan insurer coverage, claim requirements and remittance processing.

REQUIREMENTS OF THE JOB:

  • High school diploma or equivalent required
  • Minimum of one year experience in a medical billing environment preferred
  • Understanding of office procedures (problem solving and making recommendations) and prior proficient use of a personal computer to include Microsoft Office applications (Outlook, Word, Excel)
  • Working knowledge of third-party payer reimbursement guidelines (CPT, HCPC and ICD-9 & ICD-10 coding) and HCFA 1500 & UB04 billing, and their application to services rendered
  • Excellent telephone skills and typing speed minimum of 40 wpm

PHYSICAL REQUIREMENTS:

Light work exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

WORKING CONDITIONS:

The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

About Boys Town:

Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.

Our employees are our #1 supporters when it comes to achieving Boys Towns mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. Unique perks to Boys Town employees and their families include free visits to Boys Town physicians and free prescriptions under the Boys Town Medical Plan, tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.

Date Posted:February 4, 2022

This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.

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