Provider Network Specialist jobs in Nebraska

Title: Medical Billing Specialist / Revenue Cycle Specialist  

Department: Revenue Cycle Resources 

Status: Full-Time 

Locations: Remote within Nebraska, Kansas, Missouri, Kentucky, Pennsylvania, New Mexico 

Hello, We Are ruralMED! 

Join our mission of supporting rural healthcare through collaboration focused on strategically tailored services, effective leadership, and industry-specific expertise. 

When you join our team as a Medical Billing Specialist, you are not just responsible for planning, organizing, and implementing the activities of rural medical billing, you get to play a vital role in supporting rural healthcare facilities and the communities they serve. You will utilize your expertise of commercial and governmental payor policies and regulations to perform initial billing, follow-up, and denial management to ensure accuracy and compliance.  

How This Role Makes an Impact: 

• Utilizing your knowledge and skill set, you will experience the rewarding satisfaction of supporting rural healthcare facilities on their journey to thrive within the evolving landscape and achieve excellence. 
• You will work alongside a team of dedicated and driven experts who are passionate about helping each other to be the best at supporting rural healthcare with their revenue cycle prowess.  
• Applying your problem-solving and critical thinking skills, you will be empowered to take ownership and to think outside of the box to develop processes and workflows that continue to further enhance our efficacy and accuracy.  
• You will play a direct role in being a “Rev Cycle Hero” by ensuring facilities achieve accurate and compliant billing and allowing them to continue to provide their highest quality of care to their patients and communities.   

What It’s Like Working at ruralMED: 

• Our elite and highly skilled team is driven by delivering top-notch results and supporting each other to reach a new level of excellence while making a positive impact for our clients and rural healthcare. 
• Discover flexibility and autonomy with a company that understands the true value and benefits of work-life balance. 
• Personal and professional growth opportunities are encouraged, and employee engagement is not just a measurement, it is a valuable tool for achieving brilliance. 
• Our core values are not only motivational, they are the standard for how we conduct and take pride in our work. 

• It Begins With You: Own it. 
• Pave the Way. Never Settle. 
• Be Thoughtful. Be Transparent. Be Extraordinary.  
• Work Fearlessly. Celebrate the Wins.  
• Capitalize Our Strengths. Achieve Excellence.  

• Learn more about our team: https://ruralrevcycle.com/join-our-team/ 

How to Succeed in this Role: 

• Excellent Analytical, Critical Thinking, Problem-Solving, and Adaptation skills. 
• Have 3 years of rural health (CAH & RHC) medical billing experience (5 years preferred). 
• Ability to take direction and work independently. 
• Strong communication and collaboration skills.  
• Possess knowledge and previous experience in Critical Access Hospital (CAH) and Rural Health Clinic (RHC) billing.  
• Capability to effectively and efficiently navigate multiple EHR systems and payor portals.  
• Thrive in a fast-paced atmosphere and be able to flex and adjust to the highest priorities. 
• Character Traits: Solution-Based, Highly Motivated, Achiever, Positive, Genuine, Driven, Self-Disciplined, Knowledge-Seeking, Responsible.  

Stand Out and Get Bonus Points! 

• Experience with Cerner Community Works or Meditech 
• Possess advanced skills and talents with one or more Microsoft Office programs. 
• Ability to quickly pick up and learn new processes, methods, technology systems, and platforms. 

Position Summary:

The Medical Billing Specialist will be responsible for planning, organizing, and implementing the activities of rural medical billing within their assigned clientele. They will perform initial billing, follow-up, and denial management utilizing their expertise of commercial and governmental payor policies and regulations. Advanced knowledge and previous experience in Critical Access Hospital and Rural Health Clinic billing is required, as ruralMED serves primarily hospitals and clinics within rural locations

Qualifications:

Education and/or Experience:

• High School Diploma is required.
• Three (3) years of rural health (CAH & RHC) medical billing experience required, 5 years preferred
• Experience with Cerner Community Works or Meditech preferred

General Requirements/Job Duties:

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Typical functions of this position may include:

• Responsible for initial billing, follow-up, denial management, and resolution of remit posting errors within assigned clientele
• Processes electronic and paper claims in a timely and accurate manner. Ensures edits to electronic claims meet and satisfy billing compliance guidelines for electronic submission.
• Resolves clearinghouse claim errors and payer rejections
• Performs follow-up processes on denied or unpaid insurance claims. Researches, identifies, and rectifies any circumstances affecting payment and takes steps to get claim paid utilizing websites, phone calls to the payers, and/or internal inquiry
• Resolves issues in a timely manner, including requests for medical records, coordination of benefit issues, and requests for more information, by coordinating with the responsible department
• Reviews remaining balances on accounts after insurance has paid to ensure the account was processed appropriately and performs the next appropriate action
• Resolves overpaid accounts by performing payment review to determine if posting corrections are required or/and a refund is due to the insurance company
• Routinely reviews client’s KPIs to ensure account inventory is within best practice targets
• Processes adjustments or corrections to patient account(s) according to client policy guidelines.
• Resolve denied claims utilizing the payer’s designated reconsideration and appeal process
• Accurately and thoroughly documents all actions performed on an account in the appropriate area of the EHR system
• Monitors third-party contract payment arrangements, both private and governmental to ensure accurate reimbursement and performs reimbursement analysis as necessary
• Serves as an educational resource to client.

Other:

• Maintains current knowledge of billing and reimbursement rules as designated by the Centers of Medicare and Medicaid Services (CMS), Medicaid Managed Care, and other payers.
• Keeps up to date with regulations that affect collection of receivables; monitors third-party contract payment arrangements, both private and governmental.
• Communicates issues to leadership, including payer, system, or escalated account issues.
• Maintains proficient knowledge of EHR, clearinghouse, and payer systems, as well as any other systems, required for performing required job duties.
• Participates in department meetings, in-service programs, and continuing education programs.
• Maintains a professional attitude with clients. Assures confidentiality of patient and hospital information, maintaining compliance with policies and procedures.
• Other duties as assigned.

Required Knowledge, Skills and Abilities:

• Experience with Cerner Community Works or Meditech preferred
• Knowledge of medical terminology and/or insurance terminology is required.
• Proficient with Microsoft Office

Security/Access:

• Will have access to confidential information abiding by the organizations privacy policies and regulations concerning this information.

Equipment Used:

• General office equipment to include: fax, copier, computer, printer, etc.
• Telephone