Responsible for reviewing denials for commercial and government claims across physician and facility settings, and escalating appeals to payers as needed to maximize reimbursement while remaining compliant with payer contracts and CMS regulations.
Key duties include analyzing denials against contract agreements, payer medical policies, coding and authorization processes; researching reimbursement issues; ensuring timely follow-up on denials and appeals; assisting staff with workload; participating in payer meetings; and providing training on contracts and reimbursement.
Able to work from home after successfully completing training and meeting quality and production goals.
Education
- High school diploma or GED required
- College coursework in accounting or health care preferred
Experience
- 1-2 years of experience working for a third-party payer or health care provider required
- 1 year of insurance billing experience preferred
- 6 months of institutional and professional ICD and CPT coding preferred
- 6 months of experience with DRG reimbursement and outpatient reimbursement preferred
- Experience researching institutional and professional claims and payer contract reimbursement preferred
Skills and Knowledge
- Microsoft Office, including Word, Excel, and Outlook
- 10-key data entry
- Strong verbal and written communication
- Medical terminology
- Patient accounting software and payer websites
- UB and HCFA billing formats
- ICD, CPT, revenue codes, and DRG methodology
- Facility contracting rates and CMS guidelines
- WPS ANSI remark codes
- Ability to read EOBs, analyze data, work independently, and maintain confidentiality
Benefits
- Competitive pay
- Excellent benefits
- Great work environment
- Meaningful work supporting patient care and reimbursement
- Remote work available after training and performance goals are met
Location
Omaha, Nebraska, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago