Schedule: Full time days, Monday to Friday 8:00am – 5:00pm
Location: Central Billing Office at S. 42nd St.
In a career at Boys Town National Research Hospital, you join us in changing the way America cares for children and families. We are currently expanding services. Come grow with us!
Under the supervision of the Manager, Accounts Receivable, supervises all staff and functions for ambulatory denials management and follow up within patient financial services office. Serves as the overall Boys Town National Research Hospital (BTNRH) ambulatory billing expert and point of escalation, to include system set-up and claims processing, supervising follow-up specialist staff and processes to resolve unpaid, denied, or incorrectly paid insurance claims, including necessary refunds. Manages workflows for ambulatory follow-up staff, researches payer issues that result in denials and presents findings for payer trends to PFS leadership.
Supervises ambulatory and follow up specialist personnel, serving as the group’s liaison with other billing office groups, as well as people and groups outside of the billing office as it relates to insurance billing denials, aged A/R and rejections.
Continuously monitors follow-up specialist's staff's workloads and assignments, to ensure no A/R is unassigned, and that staff assignments are set-up in such a way to avoid all timely filing and appeals adjustments at or below set performance standards, as set forth by the Patient Financial Services Director.
Performs weekly audits of personnel’s productivity and ensures quality at the department’s defined standards. Compiles audit results and findings, tracks and trends each staff’s ongoing results and communicates findings to management, while coaching and mentoring staff when below standard results and trends exist.
Tracks, trends, analyzes and implements changes to fix/reduce payer denials and rejections. This includes using system and workflow updates, education of staff and work with payer representatives and management to achieve goals (quarterly and annual) within the patient financial services office, focusing on effectiveness and efficiency.
Maintains current knowledge of various payer specific contracts and policies, as they relate to denials and rejections, as well as ensuring staff is kept abreast of pertinent payer information allowing the staff to ensure BTNRH is being reimbursed correctly, while having the ability to make sound business decisions based on the current payer contract information.
Runs, validates and distributes ambulatory insurance follow up denials, rejections, performance, and production to staff and management on set schedules.
Communicates appropriately using good interpersonal skills, ensuring that a positive, professional demeanor is projected through verbal and non-verbal communications, ensuring information for patients is delivered in a manner that is supportive, timely and understandable.
Reviews adjustment requests for completion and accuracy from follow-up specialists, approves and routes adjustments correctly within the appropriate approval and turnaround time guidelines, as determined by the PFS Director.
Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.
Knowledge, Skills and Abilities Required:
Ability to communicate professionally, clearly and concisely, both orally and in writing, with all BTNRH staff, physicians and patients in all aspects of the job to allow for high levels of efficiency and promptness for patient care.
Ability to function independently and with limited supervision.
Knowledge in UB92, HCFA 1500 Hospital Insurance Claims forms and their requirements, which includes in depth knowledge of the most current version of ANSI 837 electronic claims files, loops and segments.
Knowledge in claims clearinghouse capabilities and related build and set up.
Ability to problem solve, and to apply exceptional analytical skills to creatively resolve issues and organize workload according to established priorities.
Strong attention to detail, goal oriented and confidence in making independent decisions.
Knowledge of denials and their effect on revenue cycle operations.
Knowledge of Microsoft PC applications, such as Outlook, Word and Excel.
Ability to serve as a positive role model for the billing office and to support the mission of BTNRH.
High school diploma or equivalent, required.
Associates or bachelor degree in business, healthcare or related field, preferred.
Minimum of 3 years’ experience in healthcare required with focus on claims/denials and with at least 2 years being in a supervisory role, required.
Requires high level of computer proficiency in a variety of software applications, billing systems and claims clearinghouses.
Excellent interpersonal skills, close attention to detail and analytical/organizational skills.
Ability to maintain appropriate levels of confidentiality a must.
Extensive experience of healthcare billing, reimbursement issues and rules and regulations for insurance payers, including, but not limited to, Medicare and Medicaid.
Boys Town National Research Hospital:
Boys Town National Research Hospital offers a broad range of hospital and clinic services, backed by 40 years of life-changing research to provide the latest, most innovative care to our patients. From pediatric inpatient hospitalization and surgical services, to outpatient visits, to residential care for children and adolescents with severe behavioral disorders, our board certified specialists and highly trained pediatric nurses’ focus on caring for the unique needs of children and their families. Boys Town National Research Hospital is a license acute care hospital and psychiatric residential treatment facility and accredited by The Joint Commission. Boys Town National Research Hospital is part of Boys Town, which has been committed to the care of children for over 100 years.
Our employees are our #1 supporters when it comes to achieving Boys Town’s mission, which is why we offer an array of competitive and attractive benefit options. Unique perks to Boys Town employees and their families include free visits to Boys Town Physicians, free prescriptions, tuition assistance, access to the campus Field House, parenting resources from our expects and advancement 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, national origin, disability or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.
Internal Number: 003717
About Boys Town National Research Hospital
Since the opening of Boys Town National Research Hospital in 1977, the hospital has been internationally recognized as a leader in clinical and research programs focusing on childhood deafness, visual impairment and related communication disorders. We have developed national medical programs that are now instituted in hospitals and clinics across the country.
Today, the hospital offers a broad range of clinical services, including ear, nose and throat services at the Boys Town Ear, Nose and Throat Institute, general pediatric care with Boys Town Pediatrics, and orthopaedic, internal medicine, pediatric gastroenterology, allergy, asthma, pediatric pulmonology, behavioral health, audiological and ophthalmologic care.
The hospital has expanded to offer surgical and clinical services at two Omaha locations: 555 North 30th Street in Omaha and 14000 Hospital Road on the campus of Boys Town, Nebraska.
Boys Town National Research Hospital has assembled national leaders in research who are making important contributions in the areas of genetics, hearing, language, vision and speech disorders. Applying these findings with new technologies, distance learning and the exploration of ne...w research frontiers, the opportunities for new medical diagnoses, evaluation and treatment discoveries are endless.
Accredited by The Joint Commission, Boys Town National Research Hospital is dedicated to providing leading edge clinical care, pioneering translational research and improving the lives of children and their families through applied technology and educational outreach programs. The hospital annually serves more than 40,000 children and families from across the United States.