Hospital - Insurance Follow-up & Denial Specialist​/Mon - Fri Hybrid

Hospital - Insurance Follow-up & Denial Specialist

Schedule: Full‑time, Mon – Fri 8‑5p;
Flexible, Hybrid

At Children’s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state’s only full‑service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families—from primary and specialty care to behavioral health services and everything in between. Dedicated to a People First culture, we foster an environment with joy, belonging, wellbeing, learning and growth.

The Insurance Follow‑up Specialist is responsible for corresponding with commercial or government insurance payers to address and resolve outstanding insurance balances and denials in accordance with established standards, guidelines and requirements. Conducts follow‑up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well‑written appeals.

• Follow up on insurance or government claims to research and resolve unpaid claims and denials in follow‑up work queues by contacting payers and/or patients for status.
• Obtain reimbursement information when payment and remit are both provided via paper. Communicate effectively over the phone and through written correspondence to explain why a balance is outstanding and denied using accurate and supported reasoning based on EOBs, medical records, and payer‑specific requirements. Resubmit claims with necessary information and medical records when requested by payer through paper or electronic methods to ensure payments from third‑party payors.
  
  Organize open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an online payer portal, etc. Apply a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices. Accurately document patient accounts of all actions taken in the system. Resolve work queues according to the prescribed priority and/or per the direction of management and in accordance with department expectations.
  
  Recognize when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
• Anticipate, identify, and communicate potential areas of concern or improvement within the follow‑up functions. Assist with escalated issues as necessary as directed by leadership.
• Keep current on payer requirements through workshops, newsletters, and websites.
• Comply with Federal and State billing requirements, HIPAA and EDI transaction formats.
• Other duties as assigned by leader and organization.

• High School Diploma or GED equivalent (required).
• Associate’s Degree in Business, Finance, or related field (preferred).

• Minimum 1 year of experience working in a healthcare related field, preferably with health insurance billing and reimbursement processes (required).

• Organized, self‑motivated, able to work independently of direct supervision.
• Intermediate computer skills including spreadsheets and word processing.
• Knowledge of hospital billing, collection, and reimbursement practices.
• Knowledge of medical insurance, CPT and ICD codes.
• Excellent interpersonal skills, attention to detail, critical thinking.
• Ability to troubleshoot and adapt to complex instructions.
• Ability to perform non‑complex arithmetic calculations.
• Ability to understand and apply government/commercial insurance reimbursement terms, contractual adjustments and remittance advice details.
• Ability to keep abreast of regulatory changes affecting scope of responsibility.

Children’s is an equal opportunity employer, embracing and valuing the unique strengths and differences of people. We cultivate an inclusive environment of respect and trust where we all belong. We do not discriminate based on race, ethnicity, age, gender identity, religion, disability, veteran status, or any other protected characteristic.