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Claims Denial & Appeals Specialist - Central Billing - Mon.-Fri., Flexible Day Hours FT; 40 hours/week 8am-5pm (7048)

Children's Hospital & Medical Center - Omaha Omaha, NE

Job Description

Just like the children we serve, Children's Hospital & Medical Center is growing quickly and hiring a Claims Denial & Appeals Specialist who is responsible for reviewing and analyzing claim denials, working with payors to resolve denials, tracking all denials by payor and denial category, trending recurring denials, and recommending process improvement or system edits to eliminate future denials.  Review monthly report for Denials Management Leadership Team and serve as a member of this team to provide the analytical work necessary to drive process improvement.

Essential Functions/Competencies

% of Time



  1. Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement.
  • Receives denied claims and researches appropriate appeal steps
  • Communicates directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc.  and also using appropriate reports and working queues
  • Tracks and documents all denials by payor, visit type and denial category


  1. Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials
  • Under the direction of leadership works with necessary departments (e.g., Case Management, Medical Records, Patient Access, PFS Resolution Team, etc.) in order to drive process improvement and system edits.
  • Works with the payors to understand specific reasons for denials and preventable measures available to prohibit future denials.


  1. Reviews monthly system report for the Denials Management Leadership Team
  • Prepares an analytical summary report identifying areas of concern by dollar amount, volume and new denials
  • Tracks improvement of targeted denials once process or system edits have developed to reduce/prevent future denials


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


Perform physical requirements as described in the Physical Requirements section



  1. Performs other duties as assigned





  • Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations
  • Knowledge of current coding practices in regards to billing and processing of Explanation of Benefits.  Insure that proper reimbursement has been received
  • Excellent oral and written communication skills
  • Ability to use a Windows based computer system and common business software found in Microsoft Suite (Excel, PowerPoint, Outlook etc.)
  • Ability to work independently to effectively and efficiently perform assigned duties
  • Ability to manage multiple priorities and deadlines
  • Ability to identify, review, analyze, interpret, and present complex data; and to use creative thinking and logic to investigate and solve problems including making recommendations to outside departments to eliminate future problems
  • Associate’s degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education
  • Minimum three 3 years’ experience working with commercial or government billing and reimbursement processes required





Job Details

Date Posted October 10, 2018
Date Closes January 8, 2019
Requisition 961933-12120
Address 8534 Cass Street
Located In Omaha, NE
Work At Cass 2
Department Central Billing Office
Job Type Full-time Employee
Compensation Hourly Wage, Based on Experience
8:00 am - 5:00 pm
Hours 40 hours per week; Monday - Friday
Positions Available 1
SOC Category 43-9041.01 Insurance Claims Clerks
Zipcode 68114

This job offers the following benefits

  • 403(b) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • Business Travel Accident Insurance
  • Dental
  • Dependent Life Insurance
  • Employee Assistance Program (EAP)
  • Group Homeowners and Auto
  • Group Legal
  • Life Insurance
  • Long-Term Disability
  • Maternity / Paternity / Family Leave
  • Medical
  • Prescription Drug Plan
  • Short-Term Disability
  • Supplemental Insurance
  • Vision
  • Voluntary Life Insurance
  • Bereavement Pay
  • Cafeteria / Food
  • Continuing Education Program
  • Credit Union
  • Discounts on Employer Merchandise & Services
  • Employee Referral Program
  • Financial Planning
  • Free Parking
  • Health Fair
  • Nursing Facilities
  • Paid Holidays
  • Paid Vacations
  • Tuition Reimbursement
  • Wellness Program
  • Workout Facilities
  • Achievement Awards
  • Bonus Plan
  • Merit Increases

This job requires the following skills

  • Finance / Insurance / Banking - Other Software
  • Computer Usage
  • Excellent Communications
  • Excellent Logic and Reasoning
  • Excellent Team Member
  • Positive Attitude
  • Problem Resolution
  • Medical Billing
  • Medical Claims Processing
  • Medical Coding
At a Glance
Enjoy these benefits
  • 403(b) Retirement Savings Plan
  • Dependent-Care Spending Accounts
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Accidental Death and Dismemberment
  • And More ...