We re searching for an Insurance & Government Reimbursement Specialist, collects outstanding insurance and government payor accounts and unpaid balances via telephone, email, and mail. Verifies the accuracy of all insurance and government payor payments, rebills underpayments, appeals denials and turns them into payments, and ensures accurate payor and government reimbursement on all claims.
- Follows up on outstanding insurance and government payor claims and charges in follow-up work queues and on various reports by contacting insurance or government carriers and patients for status including processing correspondence.
- Rebills underpayments, appeals denials and turns them into payments, ensures accurate reimbursement from insurance and government payors on all claims.
- Audits accounts for proper payments, coding, balances, adjustments, etc. using appropriate reports and work queues to do so.
- Reviews all secondary claims prior to submission to ensure accuracy of claim and COB registration information. If prior insurance pays more than Medicaid allowable when Medicaid is secondary, handles adjustments according to department procedures.
- Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
- Completes all requests and follow ups with medical records, pharmacy, etc. in order to ensure payments from third party payors.
- Refers adjustments to reverse any discounts/contractual posted incorrectly, per department procedures
- Keeps current on payor requirements though workshops, newsletters, and websites.
KNOWLEDGE, SKILLS AND ABILITIES
- Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities
- Knowledge of hospital and professional billing, collection and reimbursement requirements and standard practice.
- Ability to review, interpret and understand managed care contracts and EOB s with third-party payers to ensure appropriate reimbursement.
- Intermediate computer skills including the use of spreadsheet programs and word processing programs.
- Strong interpersonal skills with attention to detail and ability to organize, interpret, and present data.
- Excellent oral and written communication skills as this position will deal directly with the public daily.
- Ability to perform non-complex arithmetic calculations
EDUCATION AND EXPERIENCE
- High School diploma or GED equivalent required.
- Minimum 2 years of experience working with commercial or government billing and reimbursement processes or Associate s degree in Billing, Coding or HIM required
- Associate s degree in Billing, Coding, Business, Finance, or related filed preferred.
Children's Hospital & Medical Center - Omaha