Rev Cycle Representative I

Health Partners Plans; Philadelphia (Philadelphia County); Presencial; USD 36 000 - 52 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical

Dental

Vision

Retirement plans

Tuition assistance

Resumo da oferta

Jefferson Health Plans is seeking a Revenue Cycle Representative I in Philadelphia to manage follow-up on outstanding balances with third-party payers, patients, and internal departments. The role focuses on resolving unpaid or denied accounts and ensuring timely, accurate payments.

Primary responsibilities include contacting payers and departments to obtain necessary information, resolving claim edits, and researching discrepancies to drive resolution in a compliant manner.

Qualificações

• Epic Proficient
• Commercial and Multiplan Payer Knowledge
• Understanding of payer requirements and denials processes

Responsabilidades

• Follow-up with payers regarding unpaid or denied accounts.
• Contact third-party payers, hospital departments, and patients to obtain information required for account resolution.
• Resolve claim edits with internal departments and update adjustments as necessary.
• Analyze and research payment discrepancies to determine appropriate resolution actions.
• Communicate within designated timeframes to expedite outstanding receivables.

Conhecimentos

Epic Proficient

Commercial and Multiplan Payer Knowl

Formação académica

High School Diploma/GED

Associates or Bachelors

Descrição da oferta de emprego

Number of Positions In Requisition

1

Job Details

Revenue Cycle Representative I

Job Description

Job Summary

Responsible for the follow‑up with all third-party payers, patients, and other departments related to outstanding account balances, payment discrepancies, and executing resolution.

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Contact payers regarding unpaid or denied accounts.
• Contact third‑party payers, hospital departments, and patients to obtain information required for account resolution, i.e., unpaid, denied accounts, payment variances, etc.
• Resolve claim edits with internal departments.
• Update and reconcile adjustments as necessary.
• Analyze and research payment discrepancies. Determine and execute appropriate action for resolution.
• Contacts payers regarding unpaid accounts within designated timeframes.
• Maintains understanding of various third‑party insurance carriers and regulatory requirements as related to receiving full and proper payments.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Maintains productivity and quality requirements as defined by departmental policy.
• Demonstrated ability to work independently with minimal supervision.
• Reviews correspondence and takes appropriate action to expedite resolution of outstanding receivables with established quality/time standards.

Competencies (Knowledge, Skills, and Abilities Required)

Epic Proficient

Commercial and Multiplan Payer Knowledge

Education

High School Diploma/GED required

Associates' or Bachelors

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Thomas Jefferson University Hospitals, Inc. Primary Location Address

601 Walnut Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value.

Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research.

Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students.

Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region.

Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which we have verified content.

For more benefits information, please click here