Revenue Cycle & Denials Specialist

The Omaha Tribe of Nebraska; Macy (NE); On-site; USD 48,000 - 65,000; Full time

Job summary

The Omaha Tribe of Nebraska is seeking a Revenue Cycle Specialist to research, correct, resubmit, and resolve rejected or denied medical claims. The role involves identifying root causes, coordinating with internal teams and payers, and following claims through to final resolution.

The ideal candidate will have strong analytical skills, attention to detail, and experience with electronic clearinghouses, payer portals, and medical billing processes.

Qualifications

• AA degree or at least two years of relevant work experience in medical billing or healthcare administration.
• Ability to research billing issues, identify errors, follow procedures, and complete corrective actions promptly.
• Strong attention to detail and ability to organize work, meet deadlines, maintain documentation, and communicate effectively with internal departments and insurance payers.
• Ability to learn payer requirements, correction, resubmission, reconsideration, and appeal requirements.
• Experience reviewing electronic clearinghouse rejections, insurance denials, and payment discrepancies.
• Knowledge of Medicare, Medicaid, commercial insurance, managed care plans, and payer billing requirements.
• Familiarity with ICD-10-CM, CPT, and HCPCS coding concepts.
• Medical billing or coding certifications such as CPB or CPC are preferred.

Responsibilities

• Research rejection reasons and determine corrective action for electronic rejections.
• Correct and resubmit claims when issues can be resolved within the scope of the position.
• Coordinate with Billing Technician, registration, coding staff, providers, and other departments for additional information.
• Prepare and submit corrected claims, resubmissions, reconsiderations, and appeals as appropriate.
• Ensure corrections address original denial and track corrected claims through to resolution.
• Maintain documentation of denial reasons, corrective actions, and outcomes.
• Escalate claims requiring management review or clinical clarification.
• Follow up on denied or unpaid claims and monitor payer responses.

Skills

Research billing issues

Attention to detail

Analytical thinking

Problem solving

Written and verbal communication

Microsoft Word

Excel

Electronic clearinghouse tools

Coordination with internal departments

Education

AA degree or 2 years related experience

Knowledge of ICD-10-CM, CPT, HCPCS

Tools

Microsoft Word

Excel

Electronic clearinghouses

Practice management systems

Payer portals

Job description

The Omaha Tribe of Nebraska is seeking a Revenue Cycle Specialist to research, correct, resubmit, and resolve rejected or denied medical claims. The role involves identifying root causes, coordinating with internal teams and payers, and following claims through to final resolution.

The ideal candidate will have strong analytical skills, attention to detail, and experience with electronic clearinghouses, payer portals, and medical billing processes.