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Claims Processor

CHI Health Clinic Omaha, Nebraska
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The posted compensation range of $17.89 - $24.60 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.

Requisition ID 2025-403914 Employment Type Full Time Department Claims Processing Hours/Pay Period 80 Shift Day Weekly Schedule Monday - Friday 6:00am - 2:30pm CST Remote Yes Category Accounting and Finance
Overview

**THIS CAN BE A REMOTE OPPORTUNITY **

CHI Health strives to care for you the way you care for your patients. 

We understand you have personal responsibilities outside of your profession and also care about your well-being. 

With you in mind, we offer the following benefits to support your work/life balance:

  • Health/Dental/Vision Insurance 
  • Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
  • Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
  • Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 
  • Employee Assistance Program (EAP) for you and your family
  • Paid Time Off (PTO) 
  • Tuition Assistance for career growth and development
  • Matching 401(k) and 457(b) Retirement Programs
  • Adoption Assistance
  • Wellness Programs
  • Flexible spending accounts

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.


Responsibilities

Job Summary / Purpose
This job is responsible for submitting claims in accordance with payer regulations and applicable guidelines. An incumbent will facilitate the overall claim process through submission of both electronic and paper-based claims, resolution of claim-form edits and validation of data integrity.
Work requires an understanding of detailed billing requirements, claims attachments and claim rejections, as well as attention to detail, the ability to accurately and timely troubleshoot/resolve questions/issues and to resolve (within scope of the position) issues which may have a potential impact on revenues.


Essential Key Job Responsibilities

1) Transmits/retrieves electronic patient claims/files to and from the claims clearinghouse in accordance with established procedures.
2) Reviews claims for all necessary requirements for billing, including complete patient and insurance information; completes paper claim processing in a timely and accurate manner.
3) Resolves all claim edits, in both the billing system and the clearinghouse, accurately and timely through attention to detail and critical thinking skills in accordance with payer regulations and guidelines.
4) Identifies and researches unusual, complex or escalated issues as assigned; applies problem-solving and critical thinking skills as necessary to resolve issues within the scope of position authority.
5) Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
6) Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.

7) Other duties as assigned by management.


Qualifications

Minimum Qualifications

Required Education (for CHI Leadership Job Levels from Supervisor through President)

Does Not Apply

Required Education for Staff Job Levels

NA

Required Licensure and Certifications

NA

Required Minimum Knowledge, Skills and Abilities

  • Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
  • Knowledge of medical insurance, CPT and ICD codes.  
  • Knowledge of clinic operations related to patient registration, referrals and cash collections.
  • Knowledge of general office principles, practices, standards, systems and tools/equipment.
  • Knowledge of medical insurance, payer contract, and basic medical terminology and abbreviations.
  • Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
  • Knowledge of sources and availability of information relevant to the assigned function.
  • Knowledge of the operation and application of automated systems applicable to the assigned function.
  • Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
  • Ability to understand and apply detailed billing requirements and insurance follow-up practices.
  • Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
  • Ability to identify and articulate non-compliance with established guidelines and/or regulatory requirements.
  • Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
  • Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
  • Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
  • Ability to effectively prioritize and execute tasks while under pressure.
  • Ability to make decisions based on available information and within the scope of authority of the position.
  • Ability to demonstrate excellent customer service skills, including professional telephone interactions.
  • Ability to read, understand and communicate in English sufficient to perform the duties of the position.
  • Ability to establish and maintain effective working relationships as required by the duties of the position.
  • Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.

PREFERRED Qualifications

Graduation from a post-high school program in medical billing or other business-related field is preferred


High School Diploma or GED Preferred

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.

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Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here [PDF].

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.