Follow-up Specialist

Reduces and manages the Accounts Receivable (A/R) by reviewing and resolving unpaid claims related to clinical/facility charges. Reviews and completes daily workflow of denials and no response from insurance payers for HCFA/UBO4, chart notes/faxes and appeals worked in a timely manner to ensure claims are processed according to payer fee schedules and timely filing appeal guidelines are followed. Resolves insurance billing issues to reduce account receivable days outstanding, increase cash flow and reduce potential bad debt. Communicates and collaborates with leadership to ensure third party payer issues are resolved in a timely manner. Accurately resubmits claims for payment to prevent and reduce further rejections/denials. Communicates common denials/rejections to help streamline and improve claims submission. Monitors assigned accounts to ensure accurate and timely payment is received, while contributing to the overall health of Boys Town National Research Hospital (BTNRH) A/R.

SCHEDULE: Mon-Fri 8:00a-4:30p

MAJOR RESPONSIBILITIES & DUTIES:

• Works assigned payer denials and claims not responded to in order to ensure proper handling and maintain appropriate follow through workflows for claim resolution. When necessary, uses creative approaches and information gathered from contacting payers when new denials are presented to seek reimbursement. Determines reasons for denials and recommends the appropriate action to prevent future denials when possible.

• Determines and processes account adjustment transactions in accordance with department procedures. Completes transactions using the appropriate adjustment code allowing for account level and reporting integrity.

• Identifies and works with department members and management to resolve coding, billing, denial, and reimbursement trends along with identifying other revenue cycle problems.

• Maintains up to date knowledge of BTNRH payer contracts/fee schedules to fully understand correctness of payer response and allowances received on remittance advices.

• Maintains an in-depth understanding and expertise of assigned payer(s) billing requirements, including 837 I and 837 P loops and segments according to 5010 rules, to ensure timely and accurate response/payment, is received from third party payers.

• Maintains current knowledge of all HCFA 1500 & UB-04 electronic and paper claim elements and requirements, insurance ANSII codes and relating BTNRH registration processes that affect the accuracy of billing.

• Achieves or exceed goals and objectives set for position and/or department, maintaining productivity and quality standards, while formulating an action plan when necessary to improve personal performance.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Ability to apply moderate analytic skills to review data and trends, as well as to organize workload according to established priorities.

• Ability to maintain a positive, friendly and professional attitude at all times with patients, as well as internal and external customers.

• Ability to perform arithmetic calculations and be familiar with the use of Microsoft Office Applications (Excel, Word, Outlook, etc.) while typing consistently at a minimum of 40 wpm.

• Ability to treat all information gained with strict confidentiality.

• Ability to operate standard office machines and equipment such as a multi-line telephone, calculator, photocopier, desktop computer.

• Ability to communicate concisely, both orally and in writing, with a wide variety of people, to include managers and coordinators.

• Ability to work independently with limited supervision, as well as to function as a team player, taking initiative and demonstrating the highest professional and ethical standards to represent the Patient Financial Services department.

• Working knowledge of health care coding systems (procedural, diagnosis, modifier, remittance and others).

• Understanding and ability to utilize various electronic, web based and manual coding and payer resources.

• General understanding and knowledge of Center for Medicare and Medicaid Systems (CMS) billing and coding requirements and compliance expectations.

• Working knowledge of government and commercial health plan insurer coverage, claim requirements and remittance processing.

• Understanding of office procedures (problem solving and making recommendations) and prior proficient use of a personal computer to include Microsoft Office applications (Outlook, Word, Excel).

• Excellent telephone skills.

REQUIRED QUALIFICATIONS:

• High school diploma or equivalent required.

• Working knowledge of third party payer reimbursement guidelines (CPT, HCPC and ICD-9 & ICD-10 coding) and HCFA 1500 & UB04 billing, and their application to services rendered rquired.

• Typing speed minimum of 40 wpm rquired.

PREFERRED QUALIFICATIONS:

• Mminimum of one year experience in a medical billing environment preferred.

Diversity is more than a commitment at Boys Town—it is the foundation of who we are and what we do.

At Boys Town, we cultivate a culture of inclusion for all employees that respects their individual strengths, views, and experiences. We believe that our differences enable us to be a better team – one that makes better decisions, drives innovation, and delivers better business results.

About Boys Town:

Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.

Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities.  A unique feature for employees and their dependents enrolled in medical benefits are reduced to no cost visits for services performed by a Boys Town provider at a Boys Town location.  Additional costs savings for the employee and their dependents are found in our pharmacy benefits with low to zero-dollar co-pays on certain maintenance drugs.   Boys Town takes your mental health seriously with no cost mental health visits to an in-network provider.  We help our employees prepare for retirement with a generous match on their 401K or 401K Roth account. Additional benefits include tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.

This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.