Insurance Claims & Denials Specialist — Government/Non-Gov

UNC Health; Goldsboro (NC); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Wayne UNC Health Care in Wayne, NC is seeking a Government-Non-Government Specialist to review, submit and resolve government and nongovernment insurance accounts to achieve compliant financial resolutions.

The role involves processing denials, follow-up, and coordination with insurers, physician offices and other departments to ensure timely claims submission and accurate postings, in a hybrid work setting.

Qualifications

• High School Diploma or equivalent required.
• CRCR certification within one year of hire.
• Two years of hospital/physician insurance experience.

Responsibilities

• Review, submit and resolve assigned insurance accounts for financial resolution.
• Process government and nongovernment accounts and denials for appeals.
• Submit claims daily; respond to denials and re-bills; coordinate with insurers.
• Interact with physician offices and other departments to resolve discrepancies.
• Post adjustments and write-offs as needed; support audits and quality goals.

Skills

Organizational skills

Customer service

English communication

Education

High School Diploma or equivalent

CRCR certification within 1 year

Tools

Epic/EMR software

MS Office

Job description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:
The Government-Non-government Specialist is responsible for reviewing, submitting and resolving assigned insurance accounts to an appropriate financial resolution in accordance with regulatory, legal, and compliance guidelines
Processes all assigned government and nongovernment accounts and denials for complex financial appeals, with a goal of bringing the accounts to an appropriate financial resolution in accordance with regulatory, legal, and compliance guidelines. Follows rules for overturning appeals and rejections for these accounts. Completes additional research and coordinates with other departments, physician offices and insurers. Also performs follow-up responsibilities of a financial counselor. Assists Revenue Cycle Director in maintaining accounts receivables at appropriate levels.
Submits insurance claims to the appropriate payers on a daily basis in adherence to applicable regulatory, legal, and compliance guidelines. Assists the Manager and Director in all aspects of claims processing.

Responsibilities:
1. Works insurance related billing errors in Epic and SSI.
2. Works accounts from follow up work queues in Epic.
3. Works denials in Epic towards resolution.
4. Coordinates with other teams/departments/payors to resolve account errors.
5. Posts adjustments and write offs as needed.
6. Leverages Lead as a resource to address account issues and questions.
7. Ensures work queues are worked appropriately and timely.
8. Satisfies goals pertaining to audits, productivity and quality standards.
9. Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims, and all aspects of insurance follow-up and collections.
10. Interfaces with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write offs, refunds or other methods.
11. Researches and resolves a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims. Contacts patients, providers and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods.
12. Verifies claims adjudication utilizing appropriate resources and applications. Reconciles accounts, researches and resolves a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims.
13. Responds to any assigned correspondence in a timely, professional, and complete manner.
14. Participates and attends meetings, training seminars and in-services to develop job knowledge.
15. Meets or exceeds goals pertaining to productivity and quality expectations.
16. Assists in training teammates within the Government/Non-Government teams.
17. Serves a resource and role model for other teammates in the area.

WAYNE

Other information:

Education

High School Diploma or equivalent required, any higher education from an accredited college will supersede this requirement.

Licensure/Certification

CRCR (Certified Revenue Cycle Representative) certification from HFMA within one year of hire.

Experience

Two (2) years prior experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections).

Knowledge, Skills and Abilities

• Good organizational, follow up and attention to detail skills.

• Excellent customer service and interpersonal skills.

• Ability to read, write and communicate effectively in English.

• Proficient with MS Office, Epic/ EMR software, with the ability to learn new software rapidly.

Valid NC Driver’s License: No

If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.

BO-209

01.8522.BO-209.NON-CLIN

Job Details

Legal Employer: Wayne Health

Entity: Wayne UNC Health Care

Organization Unit: Patient Accounts

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: WAYNE MED

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.