Qureos Mentor

Children’s Nebraska

<div>Schedule: FT, Mon - Fri, 8:00 am - 4:30 pm - onsite only
At Children&rsquo;s Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the state&rsquo;s only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families&mdash;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. Turn your passion into purpose and make a difference where it matters most.
 
 
A Brief Overview
 
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.
 
 
Essential Functions
<ul><li>Follow up on insurance or government claims to research and resolve unpaid claim and denials in follow-up work queues by contacting payers and/or patients for status. &bull; Responsible for obtaining 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 on-line payer portal, etc. Apply a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices. Accurately documents patient accounts of all actions taken in the system. Responsible for resolving 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.
</li><li>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
</li><li>Keep current on payor requirements though workshops, newsletters, and websites.
</li><li>Complies with Federal and State billing requirements. Also Complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
</li>Other duties as assigned by leader and organization. 
<li>
</li></ul> 
Education Qualifications
<ul><li>High School Diploma or GED equivalent Required and
</li><li>Associate's Degree from an accredited college or university in Business, Finance, or related field Preferred
</li></ul>Experience Qualifications
<ul><li>Minimum 1 year of experience working in a healthcare related field, preferably with health insurance billing and reimbursement processes. Required
</li></ul>Skills and Abilities
<ul><li>Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities
</li><li>Intermediate computer skills including the use of spreadsheet programs and word processing programs.
</li><li>Knowledge of general concepts and practices that relate to hospital or professional billing, collection and reimbursement, the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned functions.
</li><li>Knowledge of medical insurance, CPT and ICD codes.
</li><li>Ability to demonstrate excellent interpersonal skills, demonstrating attention to detail and critical thinking skills within the context of the assigned functions, with a commitment to accuracy.
</li><li>Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
</li><li>Ability to perform non-complex arithmetic calculations
</li><li>Ability to understand and apply government/commercial insurance reimbursement terms, contractual and/or other adjustments and remittance advice details.
</li>Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility. 
<li>
</li></ul> 
Children&rsquo;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.</div>

Insurance Follow-up & Denial Specialist / FT

<div>At Children&rsquo;s, the region&rsquo;s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team&mdash;and join us in providing brighter, healthier tomorrows for the children we serve.
 
 
Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.
 
 
A Brief Overview
 
Provides operational and clinical leadership for Child Life Services. Accountable for team member supervision, professional development, and ensuring the delivery of high-quality, developmentally appropriate care that supports the psychosocial needs of pediatric patients and families. Oversees integration of Child Life services within the interdisciplinary care model. Ensures compliance with regulatory standards, supports care coordination, and advances departmental and organizational priorities through collaboration, program development, and performance improvement. Has 24-hours accountability for services within the position's span of control.
 
 
Essential Functions
<ul><li>Clinical Leadership &amp; Care Delivery
<ul><li>Ensures delivery of evidence-based, developmentally appropriate Child Life interventions
</li><li>Serves as a clinical expert and role model in patient/family-centered care
</li><li>Ensures consistent, high-quality assessments, interventions, and documentation
</li><li>Supports staff in complex cases and promotes best practices in therapeutic play and coping strategies
</li><li>Supports patient care as needed based on operational demands
</li><li>Facilitates special guest and visitor events
</li></ul></li><li>People Leadership &amp; Workforce Development
<ul><li>Supervises Child Life Specialists, volunteers, and students
</li><li>Conducts hiring, onboarding, performance evaluations, and corrective action
</li><li>Provides coaching, mentoring, and competency validation
</li><li>Promotes professional growth and certification attainment
</li></ul></li><li>Program Oversight &amp; Operations
<ul><li>Oversees student program
</li><li>Oversees daily operations, staffing, and workflow
</li><li>Ensures appropriate patient coverage, workflows and resource allocation
</li><li>Participates in budget planning and resource stewardship
</li><li>Maintains policies, procedures, and compliance standards
</li></ul></li><li>Quality Improvement &amp; Outcomes
<ul><li>Assists with establishes performance expectations and monitors outcomes
</li><li>Uses data to evaluate program effectiveness and drive improvements
</li><li>Ensures documentation meets organizational standards
</li><li>Ensures alignment with organizational quality and patient experience goals
</li></ul></li><li>Interdisciplinary Collaboration &amp; System Integration
<ul><li>Collaborates with healthcare teams to integrate Child Life into with care teams to support coordinated, efficient patient care
</li><li>Participates in committees and organizational initiatives
</li><li>Supports system-level problem solving and process improvement
</li><li>Advocates for the role of Child Life across the system
</li><li>Builds partnerships across the organization
</li></ul></li><li>Strategic &amp; Program Development
<ul><li>Leads program development and innovation
</li><li>Expands services to meet patient and organizational needs
</li>Supports community outreach and education initiatives 
<li>
</li></ul></li></ul>Education Qualifications
<ul><li>Bachelor's Degree from an accredited college or university in Child Life, Child Development, Psychology, or related field required
</li>Master's Degree from an accredited college or university in child life or related field preferred 
<li>
</li></ul>Experience Qualifications
<ul><li>Minimum 3 years&rsquo; experience working as a Child Life Specialist required and
</li><li>Progressive leadership experience, including supervision and program management preferred
</li>Experience in a pediatric or healthcare setting Required 
<li>
</li></ul>Skills and Abilities
<ul><li>Strong knowledge of child development and pediatric psychosocial care
</li><li>Leadership, communication, and team development skills
</li>Ability to manage operations and growth 
<li>
</li></ul>Licenses and Certifications
<ul><li>Health Services\BCLS - Basic Life Support through the American Heart Association required
</li>CCLS - Certified Child Life Specialist Current and valid required 
<li>
</li></ul> 
Children&rsquo;s is the very best for kids and the very best for your career! At Children&rsquo;s, we put YOU first so together, we can improve the life of every child!</div>

Supervisor Child Life Services

Join Children’s Nebraska and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Children’s Nebraska

About Company

Insurance Follow-up & Denial Specialist / FT

Supervisor Child Life Services