Reimbursement Appeals Sr Associate

Nebraska Medicine; Omaha (NE); On-site; USD 45,000 - 65,000; Full time

Job summary

Nebraska Medicine in Omaha is seeking a skilled professional to provide expertise in routine third party reimbursement. You will maintain up-to-date patient account records and respond to insurance and patient inquiries, verbally or in writing, while handling claim denials and resubmission through a standardized appeal process.

This role focuses on researching and analyzing payments, interpreting Managed Care contracts and Medicare/Medicaid rules to optimize reimbursement, and performing payment

Qualifications

• Minimum of three years experience in healthcare compliance with hospital or physician revenue cycle processes.
• High school education or equivalent required; Associate’s degree or equivalent combination of education/experience recommended.
• Knowledge of hospital and/or professional revenue cycle processes required.
• Ability to work with diverse customer base through effective verbal and written communication.
• Multi-tasking and problem solving abilities required.
• Knowledge of computer-based programs including Word and Excel.
• Strong verbal and written communication skills required.
• Strong organizational skills with detail-oriented work.
• Typing speed of 45 words per minute with 95% accuracy.

Responsibilities

• Provide expertise in routine third party reimbursement.
• Maintain up-to-date patient account records.
• Respond to insurance and patient inquiries, verbal or written.
• Handle claim denials, underpayments and resubmission of claims.
• Analyze payments and payment accuracy, compare billed charges to payment and reimbursement.
• Interpret Managed Care contracts and/or Medicare/Medicaid rules to ensure proper reimbursement/collection.
• Perform payment validation using internal/external resources.
• Review and appeal partially denied claims.
• Conduct account history research and payer remittance analysis.

Skills

Communication skills

Typing 45 wpm

Excel

Microsoft Word

Detail-oriented

Multi-tasking

Healthcare revenue cycle knowledge

Education

High school diploma or equivalent

Associate's degree or equivalent experience

Tools

Epic systems

Job description

Serious Medicine is what we do. Being extraordinary is who we are. Every colleague plays a key role in upholding this promise to our patients and their families.

Shift

First Shift (United States of America)

Shift Details

M-F

Flexible Start times between 6am - 9am

Why Work at Nebraska Medicine?

• Together. Extraordinary. Join a team that values your skills, delivering exceptional care through collaboration.
• Leading Health Network Work with the region’s top academic health network, partnering with UNMC to transform lives through education, research, and patient care.
• Dignity and Respect: We value all backgrounds and experiences, reflecting the communities we serve.
• Educational Support Enjoy up to $5,000/year in tuition assistance, a 35% discount at Clarkson College, and career advancement opportunities with covered educational costs. Enjoy support for your personal growth within the organization, from those just starting their healthcare careers to those who are years down the path.

Be part of something extraordinary at Nebraska Medicine!

Provide expertise in routine third party reimbursement. Responsible for maintaining up to date patient account records. Responds to insurance and patient inquiries, whether verbal or written. Handles insurance claim denials, underpayments and resubmission of claims. Optimizes hospital revenue by researching, auditing, identifying trends and resolving possible claim denials through a standardized appeal process. Analyzes payments and payment accuracy comparing billed charges to payment and expected reimbursement for commercial, invoice and governmental payers. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/ c ollection. Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement. Reviews, research and appeal p artially denied claims for reconsideration. Focus on working complex denials across multiple payers and/or specialties. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice.

Required Qualifications

• Minimum of three years experience healthcare compliance experience with hospital or physician revenue cycle processes required.
• High school education or equivalent required. Associate’s degree in business administration, healthcare or related field OR equivalent combination of education/experience combined (one year of education equals one year of experience required).
• Knowledge of hospital and/or professional revenue cycle processes required.
• Ability to work with diverse customer base through effective verbal and written communication required.
• Multi-tasking and problem solving abilities required.
• Knowledge of computer based programs including Microsoft Word and Excel required.
• Strong verbal and written communication skills required.
• Strong organizational skills with aptitude for detail oriented work required.
• Ability to type a minimum of 45 words per minute with 95% accuracy required.

Preferred Qualifications

• Prior experience with both hospital and physician revenue cycle with billing and Epic systems.
• Certification through hospital or professional revenue cycle organization preferred.
• Membership in hospital or professional revenue cycle organization preferred.

Nebraska Medicine is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, marital status, sex, age, national origin, disability, genetic information, sexual orientation, gender identity and protected veterans’ status.