Healthcare Claims Specialist

Omaha Tribe of Nebraska; Macy (NE); On-site; USD 42,000 - 64,000; Full time

Job summary

Omaha Tribe of Nebraska Health Center seeks a qualified Billing Specialist to prepare, submit, and review third-party claims for Medicare, Medicaid, and private payers. You will ensure accurate EHR and billing documentation, apply ICD-10-CM, CPT, HCPCS coding, and address denials with corrective submissions.

The role emphasizes HIPAA privacy, confidential handling of patient and financial information, and collaboration with insurance companies and healthcare staff to resolve billing issues.

Qualifications

• Associate's Degree in Business or two years' experience in an office/healthcare setting.
• Healthcare billing, claims processing, or medical coding experience preferred.
• Certified professional biller (CPB) and/or professional coder (CPC) preferred.

Responsibilities

• Prepare, review, and submit third-party claims to Medicare, Medicaid, and private insurance payers.
• Review electronic health records and supporting documentation to ensure claims contain accurate and complete information.
• Utilize RPMS, electronic health records, and billing software to process claims.
• Apply knowledge of ICD-10-CM, CPT, and HCPCS coding references to support accurate claim submission.
• Review Remittance Advices (RAs) and EOBs to identify payments, denials, rejections, and discrepancies.
• Research and address claim denials and rejections promptly, including submitting corrected claims and required documentation.
• Process crossover claims and assist with resubmissions and follow-up.
• Maintain knowledge of payer billing requirements, eligibility guidelines, and reimbursement policies.
• Communicate with insurance companies, providers, and staff to resolve billing issues.
• Maintain accurate billing records and protect confidential patient and financial information.

Skills

Billing procedures

HIPAA compliance

Medical terminology

EHR systems

Communication skills

Education

Associate's Degree in Business

2 years healthcare office experience

CPB/CPC preferred

Tools

RPMS

Billing software

Microsoft Word/Excel

Job description

Omaha Tribe of Nebraska Health Center seeks a qualified Billing Specialist to prepare, submit, and review third-party claims for Medicare, Medicaid, and private payers. You will ensure accurate EHR and billing documentation, apply ICD-10-CM, CPT, HCPCS coding, and address denials with corrective submissions.

The role emphasizes HIPAA privacy, confidential handling of patient and financial information, and collaboration with insurance companies and healthcare staff to resolve billing issues.