Insurance Follow-up & Denial Specialist / FT

Insurance Follow-up & Denial Specialist / FT Omaha, NE, United States Trending Job Description Schedule: FT, Mon - Fri, 8:00 am - 4:30 pm - onsite only At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth. Turn your passion into purpose and make a difference where it matters most. A Brief Overview The Insurance Follow-up Specialist is responsible for corresponding with commercial or government insurance payers to address and resolve outstanding insurance balances and denials in accordance with established standards, guidelines and requirements. The role involves following up through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. The specialist also reviews insurance remittance advices, researches denial reasons and resolves issues through well‑written appeals. Essential Functions Follow up on insurance or government claims to research and resolve unpaid claims and denials in follow‑up work queues by contacting payers and/or patients for status. Obtain reimbursement information when payment and remit are both provided via paper. Communicate effectively over the phone and through written correspondence to explain why a balance is outstanding and denied using accurate reasoning based on EOBs, medical records, and payer specific requirements. Resubmit claims with necessary information and medical records when requested by payer through paper or electronic methods to ensure payments from third party payors. Organize open accounts by denial type or payer to address in bulk with representatives over the phone or via spreadsheet and online payer portals. Apply a thorough understanding of Explanation of Benefits (EOBs) and remittance advices. Accurately document patient accounts of all actions taken in the system. Resolve work queues according to the prescribed priority, per management direction, and department expectations. Escalate appropriately and timely through defined communication and escalation channels when additional assistance is needed. Anticipate, identify, and communicate potential areas of concern or improvement within the follow‑up functions. Assist with escalated issues as necessary as directed by leadership. Keep current on payor requirements through workshops, newsletters, and websites. Comply with Federal and State billing requirements, Health Information Portability and Accountability Act (HIPAA), and Electronic Data Interface (EDI) transaction formats. Other duties as assigned by leader and organization. Education Qualifications High School Diploma or GED equivalent—Required. Associate's Degree from an accredited college or university in Business, Finance, or related field—Preferred. Experience Qualifications Minimum 1 year of experience working in a healthcare related field, preferably with health insurance billing and reimbursement processes—Required. Skills and Abilities Organized, self‑motivated, and able to work independently of direct supervision to carry out responsibilities. Intermediate computer skills including the use of spreadsheet programs and word processing programs. Knowledge of general concepts and practices that relate to hospital or professional billing, collection and reimbursement, the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned functions. Knowledge of medical insurance, CPT and ICD codes. Excellent interpersonal skills, attention to detail and critical thinking skills within the context of the assigned functions, with a commitment to accuracy. Ability to troubleshoot, understand and/or adapt moderately complex oral and/or written instructions/guidelines to diverse or dissimilar situations. Ability to perform non‑complex arithmetic calculations. Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details. Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility. Children’s is an equal opportunity employer, embracing and valuing the unique strengths and differences of people. We cultivate an inclusive environment of respect and trust where we all belong. We do not discriminate based on race, ethnicity, age, gender identity, religion, disability, veteran status, or any other protected characteristic. #J-18808-Ljbffr Children's Hospital & Medical Center