Job Description

Schedule: Monday-Friday 8:00am to 5:00pm

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. Turn your passion into purpose and make a difference where it matters most.

A Brief Overview

This position will serve as the leader and advocate for coordinating assigned functions for their teams to accomplish organizational and departmental strategic goals and objectives. This position is responsible for providing direct supervision and daily management for insurance and government collections to include claims, A/R follow-up, denials and appeals. This includes supervising, monitoring, and analyzing all activities to adhere to department standards and maximize operations revenue. Provides day-to-day work direction and guidance, including delegating work, facilitating adherence to department and organization standards and mentoring. Develops, implements and enforces goals, policies and procedures, and productivity to ensure timely resolution of third-party reimbursement, department issues. Responsible for analyzing, recommending updates and changes to EHR and clearinghouse build and coordinating testing of changes with IT team. Provides training and/or support on an as needed basis for special projects, process changes and system issues.

Essential Functions

• Leadership and Team Management:
• Supervise and provide leadership to team members, including mentoring and coaching to foster professional growth and high performance.
• Assists in outcomes management by holding self and others accountable to meet stated outcomes, objectives, goals, timetables and commitments, adhering to outcomes even in the face of unforeseen circumstances
• Prioritizes and coordinates daily work activities.
• Provides leadership and guidance by sharing expertise with others.
• Approves schedules and monitors time worked.
• Conducts employee performance management duties including completion and delivery of performance evaluations, setting goals, dissemination of information, coaching, addressing performance issues/routine correction actions, and recommending termination of employment.
• Submits notifications for personnel actions (e.g. status changes, termination, etc.)
• Participates in selection, hiring, and salary recommendations
• Coordinate onboarding and training for new hires, ensuring they are well-prepared for their roles.
• Support and execute ongoing communications to keep the team updated on system changes, policies, and best practices.
• Act as mentor and resource for team members, providing guidance on technical or procedural challenges
• Effectively manages workload with accuracy and attention to detail per requirements outline in departmental policy.
• Operational Management & Excellence:
• Develops, maintains, and implements polices, process workflows, internal controls, and procedures to achieve optimum service delivery using automation.
• Analyzes processes and procedures making recommendations and/or decisions on guidelines for daily processes/activities within the department, recommending policy changes related to the department.
• May participate in the implementation of business plans for the area.
• Responsible for the implementation and execution of business plans or activities for the assigned units.
• Makes decisions guided by the business plan and resource availability that impacts service levels and the teams’ abilities to meet objectives.
• Addresses escalated issues, questions or concerns in a timely and professional manner.
• Serves as a liaison between all inter-disciplinary team members to ensure smooth operations and to resolve related issues.
• Utilizes and recommends available resources to facilitate an outstanding patient experience.
• Ensures compliance with quality assurance, safety practices, policies, regulatory, and legal requirements.
• Assisting the department manager in the implementation of the strategic direction within the department to ensure efficient and effective day-to-day operations.
• Identifies, obtains and appropriately utilizes resources necessary to meet the identified goals including recommending budget amounts for operating expenses.
• Holds self-accountable for professional development through active participation in HFMA, CHCA and other professional organizations.
• Stays abreast of changes in the industry by keeping current with CMS, Medicaid, HIPAA and payor billing regulations as well as market changes through workshops, newsletters, and websites.
• Maintains a working knowledge of federal and state billing requirements, Electronic Data Interface (EDI) transaction formats, third-party payor contracts and federal and state medical coverage programs.
• They hold themselves accountable for professional development through active participation in HFMA, CHCA and other professional organizations.
• System Integration & Testing
• Responsible for analyzing, identifying and recommending system build needs to achieve and maintain system optimization/automation.
• Identifies and leads interdisciplinary teams' hospital-wide to improve workflow processes for billing accuracy and denial prevention.
• Serves as Revenue Cycles expert on Epic’s HB or PB billing systems. Coordinates with IT and gives final approval to system testing of new or updated system build.
• Primary back up for the other Supervisors in the CBO.

Education Qualifications

• High School Diploma or GED equivalent Required
• Bachelor's Degree from an accredited college or university in healthcare administration, business administration, finance, or related field Required or
• Equivalent relevant work experience may be substituted for education Required

Experience Qualifications

• Minimum 5 years’ experience in healthcare billing environment including AR, Denial Management, and Billing Required and
• One year lead or supervisory experience Preferred

Skills and Abilities

• Knowledge of Revenue Cycle Operations, third party reimbursement, local, state, federal regulations and medical terminology. This includes all aspects of payer relations, claims adjudication, contractual claims process and general reimbursement procedures including knowledge of CPT, HCPCS and revenue codes and their effect on hospital reimbursement. Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations.
• Strong, positive customer relations and the ability to communicate effectively both verbally and in writing
• Excellent problem solving skills
• Fosters teamwork and collaboration
• Effective conflict resolution; active listening skills
• Good Microsoft Word, Excel and PowerPoint

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.