Claims Representative Associate Jobs in Nebraska

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Work Shift

Evening

Work Day(s)

Monday, Thursday, Tuesday, Wednesday

Shift Start Time

12:30 PM11:00 PMRegular

Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's.

Serves as expert/lead team member in communicating with patients, families, physicians, quality review, clinical staff, and insurance companies to obtain information and insurance verification to ensure quality patient care and payment of hospital accounts. Collaborates with Appeals department to overturn claims denial. Provides other registration, clerical, and billing support as required, including scheduling, chart creation, and charge entry. Ensures quality monitoring to produce clean claim processing. Assists in hiring and orientation of new employees and may assist in annual evaluation process.

Experience

• Two years of experience in healthcare or related clerical, accounting, or customer service
• One year of experience in registration using patient registration systems, insurance verification systems, and/or Medicaid portals

Preferred Qualifications

• Bachelor's degree
• Certified Patient Account Representative (CPAR) or Certified Healthcare Access Associate (CHAA)

Education

• High school diploma or equivalent

Certification Summary

• No professional certifications required

Knowledge, Skills, and Abilities

• Understand and be familiar with medical terminology
• Basic knowledge of Microsoft Windows and Word
• Knowledge and utilization of patient registration systems, insurance verification systems, and/or Medicaid portals, e.g., RIS, SIS, SMS, Epic, IMS Web, HDX, Payor websites, CSC Order Indexing, POS Database, GPMS, IBEX, NueMD, and Passport
• Strong verbal/written communication skills
• Demonstrated arithmetic and word mathematical problem-solving skills
• Proven ability to multitask and must be willing to work a flexible schedule, including nights, weekends and holidays
• Ability to travel as needed to support multiple locations or different departments

Job Responsibilities

• Performs daily quality audits on team of registration coordinators to ensure all duties are performed correctly.
• Orients new employees and acts as resource for staff to resolve/handle difficult situations or answer questions.
• Partners with key stakeholders and leaders for positive patient flow and responds to issues that may arise related to safety, security, and disaster management.
• May conduct performance evaluation of staff, provide input into hiring and disciplinary actions, and may act as supervisor as required or upon absence of supervisor.
• Interviews patients and families to obtain complete and accurate demographic and financial information.
• Ensures all necessary questionnaires and forms are completed according to pre-determined requirements by government or regulatory agencies.
• Enters data into system for registration, billing, and patient tracking in a fast, efficient way to minimize patient wait times.
• Verifies insurance coverage and/or validates authorizations if applicable.
• Explains regulatory financial requirements to patient or responsible party and collects/posts deposits or deductible amounts as required (for outside clinics, could include ensuring that referring physicians have obtained prior insurance authorization as needed and rescheduling appointments if necessary).
• Assist Patient Accounting with sending clean claims preventing denials and delayed payment. Assists by providing all related information to overturn claims denial, if applicable. Serves as liaison between patient and department staff by informing patients and families of procedures and delays, answering questions, offering assistance, relaying messages, and other services that patients and families may require. Escalates immediate needs to appropriate leaders and/or clinical team members.
• Ensures wait time communication occurs by updating schedulers and patient information tools as appropriate.
• Schedules patient appointments when needed, including referral from faxes, phones, or other instructions, and contacts physician offices to resolve discrepancies.
• Coordinates all aspects of scheduling, including procedures, provider visits, and use of resources.
• May initiate and execute daily medical record maintenance while maintaining patient confidentiality, including creation of patient charts, filing encounter-specific paperwork, and maintaining correspondence via mailing/faxing with patient's primary care provider and/or specialists as necessary.
• Provides release of medical information as required.
• Participates in meetings and may represent department on committees which could include multi-disciplinary quality and service improvement teams.
• May prepare case review materials for court preparation for forensic interviewers and providers.
• Coordinates subpoena process between court system, Child Protection Center, and Children's Healthcare of Atlanta Legal department.
• Facilitates billing process for expert testimony in court cases.
• Assists supervisor and/or manager with development of staff by: being available to teammates, acting as a resource to help complete complicated/complex tasks, providing on the job training to team, and seeking out opportunities to become actively involved in staff workflow and development.
• Provides supervisor and/or manager feedback on staff performance, educational needs, and workflow status.
• May initiate and perform administrative duties to ensure efficient daily business operations, including participating in the office/department opening and closing procedures, assisting with maintaining, ordering, and restocking front office supplies, and receiving and distributing mail.

Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

2220 North Druid Hills RoadPatient Access