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PB Billing & Claims Anlyst / FT, Mon - Fri, 8:00 am - 5:00 pm, flexible

Children's Hospital & Medical Center - Omaha Omaha, NE
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FT, Mon - Fri, 8:00 am - 5:00 pm, flexible 

Were searching for a Billing & Claims Analyst to analyze professional and/or technical claims and rejections for potential issues that delay claim production; collaborates with IT to improve claims production and minimize rejections to improve first pass yields and to gain efficiencies for electronic and paper claims production.  Performs daily billing and editing of electronic and paper claims to ensure every claim is accounted for and billed successfully to insurance companies  and patients.

Essential Functions   

  • Analyzes electronic and paper claims and rejections for potential issues that delay claim production; look for and identify opportunities to optimize work flow and processes to improve the patient and employee experience. 
  • Analyzes claims daily  to make sure t payer specific billing requirements are met on a routine basis for all electronic and paper claims.
  • Reviews government and payor manuals website, and communiques for existing and new specific claim requirements on all electronic and paper claims.
  • Monitor rejections on all electronic and paper claims to determine where enhancements or fixes are needed in system edits to gain efficiencies and to prevent ongoing rejections.
  • Collaborate with CBO leadership and IT on findings to improve claims production and first pass yields.
  • Continually look for ways to improve the system, workflows  and processes to eliminate the need for paper claims.
  • Keep detailed and organized documentation on all findings and recommendations
  • Processes  claims and rejections by entering into system, moving to appropriate bucket, and directing to appropriate area for resolution.
  • Reviews all claims to make sure that payer specific billing requirements are met, follows-up on billing, determines and applies appropriate adjustments, answers inquiries, and updates accounts as necessary.
  • Ensures late charges are filed per payer and timely filing guidelines.  Request additional information from appropriate staff members when needed.
  • Files all claims in accordance with Central Billing Offices policies and procedures.
  • Organizes all claims for electronic submission or hard copy mail and forwards to appropriate third party payers.
  • Corrects all accounts in error or on hold within established timeline of receipt, including resolving bill holds on HB accounts. 
  • Verifies benefits and coverage prior to claim submission for accounts in Retro Review work queue and charge review work queues.
  • Identifies possible billing edits and rejection trends and reports findings to supervisor.
  • Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
  • Reconciles daily billing reports to payor confirmation reports, when applicable.
  • Investigates discrepancies or rejections and makes corrections where needed.
  • Have a thorough understanding of clearing house and EHR systems to assure accurate claim edits.
  • Keeps current on payor requirements though workshops, newsletters, websites and other electronic tools (Experian)
  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 with third-party payors.
  • 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.
  • Excellent interpersonal communication and organizational skills, pleasant attitude and proven ability to work effectively with others

 

EDUCATION AND EXPERIENCE:
  • Associates degree in billing, coding, business, finance, or related field required; equivalent work experience may be substituted for education.
  • Minimum 3 years of experience working with professional and/or hospital  commercial or government billing/claims with at least 2 years of experience working directly with claim editing or production

 

                             

EOE/Vets/Disabled

IND123

Make a meaningful difference improving the lives of children!

At Childrens, the regions only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring teamand join us in providing brighter, healthier tomorrows for the children we serve.

Date Posted August 5, 2022
Requisition 300000114660775
Located In Omaha, NE
SOC Category 00-0000.00
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