Schedule: Mon - Fri, 9:00 am - 5:30 pm

At Childrens Nebraska, our mission is to improve the life of every child through exceptional care, advocacy, research and education. As the states only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and familiesfrom 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
Receives information for new or existing patients from referral source or parent/caregiver. Completes insurance verification, authorizations, patient registration. Communicate proactively with ordering provider and other CHHC departments to verify and coordinate the provision of clinically appropriate products for each patient. Create and manage delivery tickets and sales order templates for warehouse items, ensuring accurate data entry into the computer software system. Maintain DME product knowledge and understanding of different DME utilized for specific therapies.

Essential Functions

Receives information on new or existing patients with new service(s) from the referral source either by a phone call or faxed order.

Receives and enters orders in the computer software for supplies, and equipment pick up delivery tickets.
For each patient there is an insurance verification and eligibility check.
Ensure insurance eligibility check is documented. Obtains verbal or written prior authorizations for all services in a timely manner and records the authorization in the computer software.
Notifies all parties involved of insurance coverage levels, or lack thereof.
Registers new patients in the computer system with complete and accurate information.
For each subsequent parent/caregiver contact verifies the patient address, phone number and insurance (eligibility check) with the parent/caregiver.

Daily multiple reviews all tasks, emails, faxes, and notes:

Incoming faxes; reviews the list and completes physician orders, by generating sales orders and/or sales order templates and reviewing accurate product fulfillment. Assigns the fax to the appropriate patient. As needed, completes steps in section one for new patients or new service referrals.
Review assigned tasks, emails, and work queues daily and take steps complete the tasks assigned, including identifying issues that can impact claims and routing to the appropriate department.
Incomplete orders; contacts clinical departments for any needed information on new orders that are held in the Incomplete order list. If the order is pending a future start date, then the insurance verification, assessment for authorization may be completed prior to the start date.
Authorization tracking; obtains the needed authorization at the beginning of service. Reassesses the need for further authorizations at the end of the authorization.
Review new orders/referrals, including verifying insurance, completing an eligibility check, assessing insurance need for authorization for the requested service, updating sales order template to include new/updated order information such as order doctor and ICD-10 codes, and documenting this information into a patient note.
Review daily emails and take calls for patient/patient families ordering ongoing monthly supply order, this includes reviewing all patient demographics, updating insurance when applicable, checks eligibility, assesses need for authorization and obtains the needed supply list, prepare the sales order, update to the correct delivery method WIP state, document all changes and communications in a patient note. Updates ICD-10 codes, demographics, and insurance information on patients as necessary.
Updates all sales order templates when necessary due to insurance change, this includes adding all items to be billed to insurance and updating price options.

Education Qualifications

High School Diploma or GED equivalent Required
Associate's Degree in Business, Finance, or related field Preferred

Experience Qualifications

Minimum of 3 years' experience in customer service setting, one of which can be experience working with insurance and/or revenue cycle related processes Required and
Experience with medical insurance plans and types of benefit coverage Preferred and
Familiar with ICD-10, CPT and HCPC coding Preferred

Skills and Abilities

Possess strong customer service skills.
Ability to communicate effectively both verbally and in writing.
The ability to use computers, fax machines and copiers.
Must have the ability to work independently to effectively and efficiently perform assigned duties.

Childrens 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.