Patient Fin Serv Rep

UNC Health Care; Durham (NC); On-site; USD 25,000 - 33,000; Full time

Job summary

UNC Health Care is seeking a reimbursement specialist to support patient accounting and insurance claim processes in Durham, NC. The role focuses on collecting payments, obtaining authorizations, and resolving denials or posting issues to ensure accurate reimbursement.

Preferred candidates have insurance or medical intake experience, with a strong background in clerical or accounting tasks. This is a full-time on-site position with a standard 40-hour work week.

Qualifications

• Three years of experience in clerical, accounting or customer service.
• Substantial knowledge of a variety of carrier policies, procedures and practices.
• No licensure or certification required.

Responsibilities

• Collect delinquent payments from patients and carriers.
• Obtain authorizations and referral approvals for services from insurance carriers; gather medical information as required.
• Post payments and denials; reconcile accounts and resolve posting issues.
• Serve as a resource for physicians, insurance carriers and patients to resolve questions related to patient accounts.

Education

High school diploma or GED

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

Performs a variety of complex duties in support of reimbursement from patients and insurance carriers. Preferred experience from the Insurance background or Medical Intake experience.

Responsibilities

1. Collect delinquent account payments from patients and carriers. Authorized to expedite garnishment of wages for payment of outstanding charges. Collect payment on delinquent accounts by processing forms, generating correspondence, responding to appeals and presenting case at hearings.
2. Contact insurance carriers to obtain authorizations and referral approvals for services and procedures. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers. Submits requested medical information to insurance carrier.
3. Evaluate accounts, billing, payments, and posting of accurate charges for a highly specialized and complex medical service such as transplant
4. Maintain data tables for systems that support Patient Accounting operations. Evaluate carrier and departmental information and determines data to be included in system tables
5. May serve as a lead worker to provide problem resolution and assistance to lower level positions.
6. Obtain information from patients to verify insurance coverage and financial status in order to obtain proper reimbursement. In cases of acute patient presentation, obtain identity of patient, insurance information, etc. or follow up with patient for information when patient is coherent.
7. Perform other office/administrative support duties. NOTE This duty should not comprise more than 40% of the position's total duties.
8. Post payments and denials to patient accounts, reconcile accounts, research and resolve a variety of problems relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims. Contact patients, physicians and insurance companies to obtain information necessary for account resolution through write-offs, reversals, adjustments, refunds or other methods.
9. Process a variety of forms that may be complicated by legal issues (Psychiatry, patient confidentiality) in accordance with UNCHCS policies and procedures. Input information into variety of systems
10. Research and determine if carrier denial of claim is valid. Abstract information from medical records to support appeal of carrier denials and/or make recommendations to change coding of charges in accordance with ICD-9 and CPT codes. Resolve denials of claims with carriers and patients.
11. Researches, analyzes, resolves and collects patient accounts receivable. Utilizes a variety of systems to analyze insurance and demographic information responds to requests for account information processes a variety of records and reports and contacts third party carriers, patients and employers to resolve outstanding accounts. Accurately documents collection activities performed on outstanding accounts receivable.
12. Serve as a resource for physicians, insurance carriers and patients to resolve questions/ problems pertaining to patient accounts.
13. When dealing with indigent patients, expedite completion of applications for Medicaid and other programs (via GFS) by reviewing applications for accuracy and completeness. Advise patients of programs available to provide coverage and persuades patients to apply. Establish payment plans for patients who have no method of payment when all options are exhausted.

Other Information

Other information:

Education Requirements

• High school diploma or GED required; higher-level degree may satisfy this requirement.

Licensure/Certification Requirements

• No licensure or certification required.

Professional Experience Requirements

• Three (3) years of experience in a clerical, accounting or customer service setting

Knowledge/Skills/and Abilities Requirements

• Substantial knowledge of a variety of carrier policies, procedures and practices is required.

Job Details

Legal Employer: NCHEALTH

Entity: UNC REX Healthcare

Organization Unit: UNC Homecare Admin

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range:$18.00 - $24.66 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: US:NC:Durham

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

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.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [e-mail] if you need a reasonable accommodation to search and/or to apply for a career opportunity.