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Position Type: Regular
Scheduled Hours per 2 week Pay Period: 80
Primary Location: NE > LINCOLN > THE PHYSICIAN NETWORK
Your time at work should be fulfilling. Rewarding. Inspiring. That?s what you?ll find when you join one of our
non-profit CHI facilities across the nation. You?ll find challenging, rewarding
work every day alongside people who have as much compassion as you. Join us and
together we?ll create healthier, stronger communities. Imagine your career
at?Catholic Health Initiatives!
?
Job Responsibilities
This job is responsible for corresponding with both commercial and government
health insurance payers to address and resolve outstanding insurance balances
related to coding denials in accordance with established standards, guidelines
and requirements.? An incumbent conducts
follow-up process activities through review of medical records and contact with
providers, phone calls, online processing, fax and written correspondence,
leveraging work queues to organize work efficiently.? Work also includes reviewing insurance
remittance advices, researching denial reasons and resolving issues through
well-written appeals.
Work requires proactive troubleshooting,
significant attention to detail and the application of analytical/critical
thinking skills to analyze denials and reimbursement methodologies and bring
timely resolution to issues that have a potential impact on revenues.?
Additional responsibilities for this health care role include:
Follows-up
with insurance payers to research and resolve unpaid insurance accounts
receivable; makes necessary corrections in the practice management system to
ensure appropriate reimbursement is receive.
Applies a thorough understanding/interpretationof Explanation of Benefits (EOBs) and remittance advices, including when andhow to ensure that correct and appropriate payment has been received.
Communicates effectively overthe phone and through written correspondence to explain why a balance isoutstanding, denied and/or underpaid using accurate and supported reasoningbased on EOBs, reimbursement, and payer specific requirements.
Review patient medical recordto compare documentation and coding; change coding based on documentation toinclude diagnosis codes, modifiers, place of service, etc.? Communicate with provider to resolve claimsthat require a written appeal or second level appeal.
Resubmits claims with necessaryinformation when requested through paper or electronic methods.??
Anticipates potential areas ofconcern within the follow-up function; identify issues/trends and conductsstaff training to address and rectify.
Recognizes when additionalassistance is needed to resolve insurance balances and escalates appropriatelyand timely through defined communication and escalation channels.
Resolves work queues accordingto the prescribed priority and/or per the direction of management and inaccordance with policies, procedures and other job aides.
Assists with unusual, complexor escalated issues as necessary.?Job RequirementsExperience
Three years of revenue cycle or related work experience that demonstratesattainment of the requisite job knowledge and abilities.??
?
Education/Licensure
Required:
High school/GED?
?
Preffered Qualifications:
Graduation from a post-high school program in medical billing or otherbusiness-related field is preferred.
Certification (AHIMA, CPC, or CCS-P)
2 years coding experience?
?
?
Join us
at Catholic Health Initiatives, and become a part of our faith-based health
system.
Additional Information
Requisition ID: 2019-R0217261
Schedule: Full-time
Market: CHI Health
Associated topics: bacteria, diet, dietary, food scientist, histologist, injury, pharmacy, physiology, therapeutic, therapy

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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