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Reimbursement Representative FT; 40 hrs/wk Days M-F (9062)

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

When you work at Children’s, you’re part of a treasured place of healing in the Omaha community—and beyond. Join our team of highly engaged, caring professionals who believe deeply in the organization’s mission—to improve the life of every child. We support equity, diversity and inclusion, and as you apply your skills and expertise to helping children, you too will have opportunities to grow your career. In 2021, we’ll open the new Hubbard Center for Children, tripling our capacity to serve children.

When children are your everything, anything can be…

Children's is looking to hire a Reimbursement Representative, Home Health Billing to performs patient account receivable functions including claim submission, follow-up and collection in a timely and accurate manner.

Essential Functions/Competencies

% of Time

 

95%

  1. Validates the accuracy of all billed charges and of all new patient reimbursement files including complete patient, responsible party and insurance information by reviewing the order edit and billing edit lists and noting any necessary changes, fixes or additions.
  2. Recognizes potential reimbursement issues as they arise and communicates status of issues with the Billing Lead.
  3. Makes individual patient account receivable recommendations as necessary and communicates the information to the Billing Lead.
  4. Prepare, format and mail all insurance claims according to specific contract/payer requirements.
  5. Remains knowledgeable of third-party payer contracts, federal and state medical coverage programs and requirements as well as being knowledgeable on HIPAA regulations and guidelines.
  6. Completes claim follow-up calls on claims 30 days outstanding from the submission date.
  7. Receives and verifies all payments, adjustments, and patient balances to ensure receipt of proper payment according to contractual allowable.  Records any necessary adjustments.
  8. Performs claim appeal functions upon receipt of EOB’s.  Follows-up on outstanding claims with insurance carrier and patient for status including processing correspondence, resubmitted denied claims and claims that are inaccurately processed.
  9. Process all account refunds within 30 days of identification.
  10. Coordinates with Payment Posting to determine which accounts will receive final notices. Monitors collection activity
  11. Determine which accounts will be forwarded to the collection agency.
  12. Monitors collection activity on self-pay balances in an organized and timely manner.  Reviews accounts prior to sending to collection for possible charity care.
  13. Responds to 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.
  14. Review Account Receivable aging report and perform follow-up as required for aged amounts outstanding.
  15. Review and mail monthly billing statements.

 

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

 

Perform physical requirements as described in the Physical Requirements section

SECONDARY FUNCTIONS/COMPETENCIES

5%

  • Serves as backup to the receptionist.
  • Performs other duties as assigned.

100%

 

KNOWLEDGE, 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. 
EDUCATION AND EXPERIENCE:
  • High school diploma or GED required.
  • Minimum 1 year experience with medical insurance plans and types of benefit coverage required.
  • Experience working with ICD-10, CPT and HCPC coding preferred
  • Experience with universal billing forms such as UB04 and HCFA 1500 preferred.

     

EOE/VETS/DISABLED

Job Details

Date Posted May 18, 2020
Requisition 1324-5302
Address 4156 South 52nd Street
Located In Omaha, NE
Work At Home Health
Department Home Health Billing
Job Type Full-time Employee
Compensation Hourly Wage, Based on Experience
Experience Level Entry Level (0-2 yrs. experience)
Shift
Daytime
m-f
Hours 40 hours per week
Positions Available 1
SOC Category 43-3021.03 Billing, Posting, and Calculating Machine Operators
Zipcode 68117

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

  • Insurance Claims Processing - Health
  • Computer Usage
  • Excellent Communications
  • Excellent Logic and Reasoning
  • Excellent Team Member
  • Positive Attitude
  • 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 ...
Location