Sr. Denials Management Analyst

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, 7:00am to 3:30pm

Provide an escalated support level for facility and physician payer reimbursement related to denials, refunds and other contractual payment issues.

Responsibilities:

Essential Job Functions

1. Serve as a resource for resolution of payer claim payment/denial issues, working with necessary staff to achieve closure.

2. Reconcile payer explanation of benefits and payments to determine if proper reimbursement has been received, according to fee schedules.

3. Work with payer or patient to obtain contractual payments when discrepancies are discovered.

4. Maintain a working knowledge of payer specific regulatory issues, insurance updates and departmental functions.

5. Assist with new employee orientation and training, providing feedback to employee and supervisor on work performance.

6. Ensure management is informed of issues with denials, balances and workflow issues.

7. Participate in process improvement activities, providing recommendations to increase efficiency.

8. Develop and maintain documentation of work duties.

9. Perform duties of other departmental staff as needed to maintain productivity.

10. Test updates or changes to systems used in the department.

Schedule:

Mon - Fri, 7:00am to 3:30pm

Job Description:

Job Requirements

Education

- High school diploma or equivalent required.
- College courses in accounting and or health care preferred.
- Coursework in medical terminology preferred.

Experience

- Minimum 3 years of 3rd party payer or health care provider billing experience required.
- Experience with physician and or facility billing experience required.
- Experience reconciling patient accounts and balancing payment transactions against contract rates and terms required.
- Minimum of one year lead or supervisor experience preferred.
- Experience with government and managed care contracts and government regulations preferred.

License/Certifications

- N/A

Skills/Knowledge/Abilities

- Skill using Microsoft Office, including Word, Excel, and Outlook.
- Skill performing 10 key data entry.
- Skill with verbal and written communication.
- Knowledge of patient accounting software and payer websites.
- Knowledge of Universal Billing (UB) and Healthcare Financing Administration (HCFA) billing formats.
- Knowledge of International Classification of Disease (ICD), Current Procedural Terminology (CPT), Revenue Codes, understanding of DRG methodology.
- Knowledge of facility contracting rates.
- Knowledge of CMS (Center for Medicare and Medicaid Services).
- Knowledge of WPS ANSI remark codes.
- Ability to maintain confidentiality.
- Ability to read and understand payer explanation of benefits (EOB).
- Ability to use basic accounting and math principles.
- Ability to identify, trend and analyze data.
- Ability to learn new software programs.
- Ability to organize and prioritize work.
- Ability to work independently.
- Ability to identify and trend issues to improve or streamline processes.

Physical Requirements

Weight Demands

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

Physical Activity

- Not necessary for the position (0%): Climbing
- Crawling
- Kneeling

- Occasionally Performed (1%-33%): Balancing
- Carrying
- Crouching
- Distinguish colors
- Lifting
- Pulling/Pushing
- Standing
- Stooping/bending
- Twisting
- Walking

- Frequently Performed (34%-66%): Grasping
- Keyboarding/typing
- Reaching
- Repetitive Motions
- Speaking/talking

- Constantly Performed (67%-100%): Hearing
- Seeing/Visual
- Sitting

Job Hazards

- Not Related: Chemical agents (Toxic, Corrosive, Flammable, Latex)
- 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)
- 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 Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.