FFS Payments Reviewer
State of Nebraska

Lincoln, Nebraska

Posted in Public Sector and Government


This job has expired.

Job Info


Description
Nebraska Department of Health and Human Services is about "Helping People Live Better Lives" and through the Division of Medicaid and Long-Term Care (MLTC), we have an opening for a Fee-for-Service (FFS) Payments Reviewer. MLTC encompasses the Medicaid program, Home and Community-Based Services for the aged and persons with disabilities and the State Unit on Aging. Home and Community-Based Services provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than isolated settings. We are seeking an FFS Payments Reviewer to review Medicaid claims and associated provider documents required for claims processing, payments or denials. The successful incumbent will be very detailed oriented.

DHHS State of Nebraska values our employees as well as a supportive environment that strives to promote Diversity, Inclusion, and Belonging. We recruit, hire, train, and promote in all job qualifications and at all levels without regard to race, color, religion, sex, age, national origin, disability, marital status, sexual orientation, or genetics.

Location: Nebraska State Office Building - Lincoln, NE

Schedule: 8-5; M-F
Examples of Work
As a Fee-For-Service payments reviewer you will:
• Review Medicaid claims and associated provider documents required for claims processing, payments or denials
• Determine that payment amounts for services are correct and generate computerized payments
• Answer questions and/or resolve problems involving non-routine handling of forms and documents submitted for updating claims
• Make any other adjustments authorized by established policies and procedures
• Answer telephone or written inquiries from providers regarding status of suspended or deleted claims and trading partners that submit electronic claims and work to resolve any related questions while maintaining effective public relations. Provide assistance to end users, both internal and external, of departmental software applications and business processes.
• Perform related work as assigned
• Be consistent with policies, procedures, and department guidelines as well as state and Federal regulations
• Provide excellent customer service
• Adhere to DHHS values and core competencies.
• The position will include periodic work assisting the EDI (electronic data interchange) help desk which includes providing assistance to end users, both internal and external; assisting in resolving communications problems; creating user access and identifications for security purposes; maintaining the database on external users, and processing trading partner authorization.
Qualifications / Requirements
REQUIREMENTS: Coursework/training in administrative/office support functions, procedures, and methods including the operation of personal computers and office equipment; or areas related to the programs and functions of the employing agency. OR Experience in customer service or public contact; or applying criteria/regulations; and/or performing administrative/office/secretarial support work including use of personal computers and office equipment.

PREFERRED: Experience in performing office/clerical or accounting support functions including the use of personal computers and office equipment Experience with Medicaid Management Information System (MMIS), N-FOCUS, and OnBase computer programs. Familiar with medical terminology. Experience with medical claim forms, insurance EOBs (Explanation of Benefits), Microsoft Office Suite products and customer service experience.
Knowledge, Skills and Abilities
Experience with Oracle (Enterprise One), Microsoft Word and Excel. Ability to organize personal work assignments; file and retrieve records/documents in accordance with an established system; learn and apply agency policies, guidelines and regulations pertinent to FFS claims processing; identify similarities and differences between two or more sets of data; write legibly; communicate with agency staff and the public in person and via telephone; understand and carry out instructions; interact with co-workers, government officials and the public.


This job has expired.

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