Responsible for monitoring payer denials, payment variances, and reimbursement integrity to help ensure organizational goals are met. This role identifies, appeals, and tracks payer denials, works to recover third-party contractual underpayments, and analyzes data to support process improvement.
Key responsibilities include:
- Reviewing contract reimbursement and comparing expected vs. actual reimbursement
- Preparing and analyzing reports on third-party payer activity
- Determining root causes of denials and underpayments
- Communicating payment discrepancies to leadership and finance teams
- Resolving incorrect payments with payers and escalating unresolved issues
- Advising departments on reimbursement-related regulatory changes
- Supporting managed care contract payment accuracy
- Completing appeals and payer audits, including RAC, MAC, CERT, and QIO audits
- Identifying contract management errors and supporting reimbursement corrections
- Participating in meetings, committees, and department projects
Requirements & Qualifications
Required knowledge and skills include:
- Knowledge of third-party payer processes, including Medicare, Medicaid, and commercial insurance
- Understanding of appeal and reconsideration requirements
- Familiarity with billing and accounts receivable management
- Knowledge of CPT, ICD-10, revenue, DRG, APC, and EAPG coding/reimbursement methodologies
- Awareness of regulatory and compliance requirements related to reimbursement
- Knowledge of hospital managed care contracts and implementation standards
- Strong analytical, problem-solving, and reporting skills
- Ability to communicate effectively verbally and in writing
- Ability to prioritize work, meet deadlines, and work with minimal supervision
- Ability to maintain confidentiality and effective working relationships
Education and experience:
- High school diploma or equivalent required
- At least 1 year of college coursework in accounting, coding, insurance, or a related field required
- 3+ years of insurance billing experience in a hospital or professional environment preferred
Location
Lincoln, Nebraska, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 week ago