Pediatric Insurance Denials & Follow-Up Specialist

Children's Nebraska; Omaha (NE); On-site; USD 42,000 - 64,000; Full time

Job summary

Children’s Nebraska is seeking an Insurance Follow-up Specialist to manage communication with commercial or government payers and resolve outstanding balances and denials. Responsibilities include researching denial reasons, submitting appeals, and maintaining accurate patient account documentation.

The role emphasizes strong organization, attention to detail, and the ability to work independently within HIPAA and EDI compliance guidelines. Monday–Friday, onsite in Omaha, NE.

Qualifications

• High School Diploma or GED required.
• Associates degree in Business/Finance or related field preferred.
• 1 year of healthcare-related experience, especially billing/reimbursement, is required.

Responsibilities

• Follow up on insurance claims and denials by contacting payers or patients.
• Obtain reimbursement information when payments are provided on paper.
• Explain balances and denials using EOBs and payer requirements.
• Resubmit claims with necessary information and records upon payer request.
• Organize open accounts by denial type or payer and work with teams via portals or spreadsheets.
• Interpret Explanation of Benefits and remittance advice accurately.
• Document all actions taken in the system for patient accounts.
• Resolve queues per priority and management direction.
• Escalate issues to leadership when additional assistance is needed.
• Stay current on payor requirements through training and updates.
• Comply with HIPAA, HIPAA, and EDI formats.

Skills

Organized

Interpersonal skills

Attention to detail

Critical thinking

Independent work

Education

High School Diploma or GED

Associate's Degree in Business/Finance Preferred

Tools

Microsoft Excel

Microsoft Word

Payer portals

Job description

Children’s Nebraska is seeking an Insurance Follow-up Specialist to manage communication with commercial or government payers and resolve outstanding balances and denials. Responsibilities include researching denial reasons, submitting appeals, and maintaining accurate patient account documentation.

The role emphasizes strong organization, attention to detail, and the ability to work independently within HIPAA and EDI compliance guidelines. Monday–Friday, onsite in Omaha, NE.