Revenue Cycle Representative

UNC Health; Eastowne (NC); Hybrid; USD 25,000 - 35,000; Full time

Job summary

UNC Health in Chapel Hill, NC is seeking a claims follow-up specialist to manage insurance claims, follow up on denials, and perform related billing duties within a shared services environment. The role emphasizes accuracy, timely submission, and working with internal/external departments to resolve discrepancies.

Ideal candidates will have at least two years of hospital or physician insurance experience and be comfortable with hybrid work.

Qualifications

• Two (2) years of experience in hospital or physician insurance related activities.

Responsibilities

• Submit and follow up insurance claims, including denials and re-bills.
• Research medical records to substantiate medical procedures for insurance,
• Respond to denials and appeals and communicate with payors.
• Identify issues and trends and provide suggestions for resolution to management.

Education

High School Degree

Job description

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

• Responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials.
• Works physician claims ("professional billing").
• Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims.
• *Performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy.

Job Responsibilities

• Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals, response to denials, and re-bills of insurance claims, and all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write-offs, other methods.
• Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
• Submit requested medical information to insurance carrier.
• Responsible for the analysis and necessary corrections of invoices or accounts and maintaining work queues.
• Access, review and respond to third party correspondence.
• Research and resolve 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.
• Contact insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments or other methods.
• Verify claims adjudication utilizing appropriate resources and applications.
• Reconcile accounts, research and resolve a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims.
• Respond to any assigned correspondence in a timely, professional, and complete manner.
• Identify issues and/or trends and provide suggestions for resolution to management, including payer, system or escalated account issues.
• May maintain data tables for systems that support PB Claims operations.
• Evaluate carrier and departmental information and determines data to be included in system tables.
• Read and interpret EOB's (Explanation of Benefits).
• Maintain basic understanding and knowledge of health insurance plans, policies and procedures.
• Accurately and thoroughly document the pertinent collection activity performed.
• Participate and attend meetings, training seminars and in-services to develop job knowledge.
• Meet/Exceed Productivity and Quality standards.

Other Information

Other information:
Education Requirements:
* High School Degree
Licensure/Certification Requirements:
Professional Experience Requirements:
* Two (2) years of experience in hospital or physician insurance related activities ((Authorization, Billing, Follow-Up, Call-Center, or Collections)
Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Physician Ins Billing and Foll

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range:$18.12 - $25.51 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

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 Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

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.