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Reimbursement Appeals Sr Associate

Nebraska Medicine locationOmaha, NE
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295 positions
295 positions
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Job Location
Omaha, NE, United States


Serious Medicine is what we do. Being extraordinary is who we are. Every colleague plays a key role in upholding this promise to our patients and their families.

Please note that this position may require an assessment after completion of the application. Please plan for an additional 20 - 30 minutes to complete this.


First Shift (United States of America)

Reimbursement Appeals Sr Associate

Reimbursement Appeals Sr Associate

Shift Details:

Monday - Friday; 1st shift

Why Nebraska Medicine:

Our shared values reflect who we are and why we're here and include, Innovation, Teamwork, Excellence, Accountability, Courage and Healing.

* Competitive Benefits including retirement match contribution, PTO accrual, tuition reimbursement

* Lead the world in transforming lives to create a healthy future for all individuals and communities through premier educational programs, innovative research and extraordinary patient care

* Forbes Magazine recognizes us in their list of American's top employers and the best employer in Nebraska

Provide expertise in routine third party reimbursement. Responsible for maintaining up to date patient account records. Responds to insurance and patient inquiries, whether verbal or written. Handles insurance claim denials, underpayments and resubmission of claims. Optimizes hospital revenue by researching, auditing, identifying trends and resolving possible claim denials through a standardized appeal process. Analyzes payments and payment accuracy comparing billed charges to payment and expected reimbursement for commercial, invoice and governmental payers. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/ c ollection. Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement. Reviews, research and appeal p artially denied claims for reconsideration. Focus on working complex denials across multiple payers and/or specialties. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice.

Required Qualifications:

  • Minimum of three years experience healthcare compliance experience with hospital or physician revenue cycle processes required.
  • High school education or equivalent required. Associate's degree in business administration, healthcare or related field OR equivalent combination of education/experience combined (one year of education equals one year of experience required).
  • Knowledge of hospital and/or professional revenue cycle processes required.
  • Ability to work with diverse customer base through effective verbal and written communication required.
  • Multi-tasking and problem solving abilities required.
  • Knowledge of computer based programs including Microsoft Word and Excel required.
  • Strong verbal and written communication skills required.
  • Strong organizational skills with aptitude for detail oriented work required.
  • Ability to type a minimum of 45 words per minute with 95% accuracy required.

Preferred Qualifications:

  • Prior experience with both hospital and physician revenue cycle with billing and Epic systems.
  • Certification through hospital or professional revenue cycle organization preferred.
  • Membership in hospital or professional revenue cycle organization preferred.

Working at Nebraska Medicine means you're committing to meaningful, impactful work that will elevate the success of your fellow colleagues and will help our patients and their families feel comfortable, confident and cared for.

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