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Location

Omaha, NE | United States

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Job description

Overview

REMOTE WORK OPPORTUNITY

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.

CHI Health provides you with the same level of care you provide for others. We care about our employees’ well-being and offer benefits that complement work/life balance.

With you in mind, we offer the following benefits to support your work/life balance:

• Health/Dental/Vision Insurance 
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO) 
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
• Flexible spending accounts

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

Responsibilities

ESSENTIAL KEY JOB RESPONSIBILITIES

1. Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
2. Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
3. Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal.
4. Resubmits claims with necessary information when requested through paper or electronic methods.
5. Anticipate potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
6. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
7. Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
8. Assists with unusual, complex or escalated issues as necessary.
9. Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
10. Accurately documents patient accounts of all actions taken in billing system.
11. Other duties as assigned by management.

Qualifications

MINIMUM QUALIFICATIONS

Required Minimum Knowledge, Skills and Abilities :

Knowledge of health insurance, including coding.
Ability to communicate effectively and efficiently.
Proficient computer skills,with the ability to learn applicable internal systems.
Ability to work collaboratively with others toward the accomplishment of shared goals.

HIGHLY PREFERRED Qualifications

High school diploma or equivalent preferred
Associates degree in related field
Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology.
Completion of ICD-10 or CPT coding course.
1+ years coding experience
Insurance follow up experience
CPC Certification

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Job tags

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Salary