Patient Billing Rep I

Nebraska Methodist Health System; Omaha (NE); On-site; USD 40,000 - 62,000; Full time

Job summary

Nebraska Methodist Health System in Omaha, NE is seeking a Billing Specialist to manage electronic and paper claims, follow up with payers, and ensure timely reimbursement. The role requires precise data entry, knowledge of UB04/CMS1500, and ability to audit accounts while delivering professional service to patients and staff.

Strong communication, accuracy, and adherence to department guidelines are essential for success in this role in a busy health system environment.

Qualifications

• High school diploma or GED required. AHIMA coursework preferred in Coding, Billing or Healthcare Management.
• Experience in healthcare third party billing and/or claims processing is preferred.
• Ability to interpret UB04 and CMS1500 claim data and troubleshoot payer requirements.

Responsibilities

• Process electronic and hardcopy billing following department and payer guidelines.
• Obtain EOBs through health system resources.
• Review billing scrubber detail screens for correct claim submission.
• Prepare secondary and tertiary billings on UB04 and CMS1500 forms.
• Submit adjusted claims as required by guidelines.
• Follow up with third party payers and document actions in Source System.
• Audit patient accounts and document findings and actions taken.
• Manage referrals timely and accurately within department guidelines.
• Maintain knowledge of system applications and continuous learning.
• Maintain daily workflow and accurate documentation in Source System.

Skills

Communication skills

Claim data interpretation

Accounting basics

Documentation

Payer follow-up

Education

High school diploma or GED

AHIMA coursework in Coding / Billing / Healthcare Management

Tools

Source System

Job description

Why work for Nebraska Methodist Health System?

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary

Location: Methodist Corporate Office

Address: 825 S 169th St. - Omaha, NE

Work Schedule: Mon - Fri, daytime business office hours

Responsible for billing, electronic claims submission, follow up and collections of patient accounts.

Responsibilities

Electronic and Hardcopy Billing

• All EDI and paper claims submitted are to be billed as needed following department and payer specific guidelines.
• Obtains appropriate EOB's through use of health system resources.
• Reviews Billing Scrubber Claim Detail Screens to ensure data is appropriate for claim submission.
• Ensure that claim corrections identified in billing scrubber are appropriately updated and documented in Source System.
• Prepares secondary and tertiary billings, manually and electronically on UB04's and/or 1500's for accurate reimbursement.
• Submits adjusted UB04/837I and/or CMS1500/837P claims according to department and payer specific guidelines.

Display Effective Communication Skills

• Demonstrates active listening skills.
• Notifies and keeps leads and supervisors informed on issues identified.
• Follows telephone etiquette procedures set forth by the organization and/or individual department.
• Professional/Courteous responses when communicating with customers, health system staff and management.

Handling of Referrals

• Timely and accurately handling of referrals, both regular and escalated priority from management, within department guidelines.
• Documents clearly and appropriately all referrals (including patient inquiries) in the Source System when necessary.
• If necessary, follows up with patients on final results of inquiry both timely and professionally. Notifies patient of final results of account handling in question.

Knowledge of System Applications

• Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.
• Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines.

Auditing of Patient Accounts

• Understand accounting and business principles to accurately determine the remaining balance on a given encounter.
• Upon accurately auditing encounter or visit, is able to understand and update proration to make sure dollars are allocated to the appropriate benefit orders if needed.
• Leverages all needed resources to complete an audit of an account.
• Documents audit finding and actions taken in Source System when necessary.

Claim Follow Up with Third Party Payers

• Full understanding of all necessary third party billing and follow up processes based on department specifications.
• Full understanding of all necessary contract related requirements.
• Leverages payer websites and necessary tools to streamline the follow up process.
• Appropriate documentation in Source System when necessary.
• Ability to interpret correspondence assigned for accurate handling.

Special Projects and Tasks as Assigned

• Completion of any assigned projects timely, accurately and to the specifications of leadership.
• Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.

Maintaining Daily Workflow

• Manages and maintains assigned workflow queues according to department guidelines.
• Mail/Correspondence processed and handled following departmental guidelines.
• Documents both timely and appropriately in Source System using proper documentation methods.
• Fundamental understanding of different work item, state based and exception queues within the Patient Accounting System applications.

Schedule

Mon - Fri, daytime business office hours

Job Requirements

Education

• High school diploma, General Educational Development (GED) or equivalent required
• Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Heath Information Management Association (AHIMA) preferred.

Experience

• Minimum of one (1) year prior experience in healthcare third party billing and/or claims processing preferred.
• Prior exposure to UP04 and/or CMS1500 claim data normally acquired through work in a physician’s office or other healthcare setting preferred.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.
• Ability to create and submit both original and corrected claims.
• Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.
• Ability to use effective communication skills in order to handle patient inquires, attorneys, health system staff and payers on a professional level.
• Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts.
• Ability to follow up with the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.
• Ability to maintain a working knowledge of multiple system applications.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Occasionally Performed (1%-33%):
  • Balancing
  • Climbing
  • Carrying
  • Crawling
  • Crouching
  • Distinguish colors
  • Kneeling
  • Lifting
  • Pulling/Pushing
  • Reaching
  • Standing
  • Stooping/bending
  • Twisting
  • Walking
• Frequently Performed (34%-66%):
  • Hearing
  • Repetitive Motions
  • Seeing/Visual
  • Speaking/talking
• Constantly Performed (67%-100%):
  • Fingering/Touching
  • Grasping
  • Keyboarding/typing
  • Sitting

Job Hazards

• Not Related:
  • Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
  • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
  • Equipment/Machinery/Tools
  • Explosives (pressurized gas)
  • Electrical Shock/Static
  • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
  • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Rare (1-33%):
  • Chemical agents (Toxic, Corrosive, Flammable, Latex)
  • Mechanical moving parts/vibrations

About Methodist

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affir...