Revenue Cycle Representative

UNC Health Wayne; Rocky Mount (NC); Hybrid; USD 42,000 - 54,000; Full time

Job summary

UNC Health Nash is seeking a Revenue Cycle Representative to manage the end-to-end claims process, follow up on payer responses, and resolve denials. You will maintain clean submissions and collaborate with multiple departments to ensure timely payments and accurate billing.

The role emphasizes attention to detail, data accuracy, and strong communication with patients and insurers. This hybrid 40-hour week position supports Nash UNC Health Care in North Carolina.

Qualifications

• High school diploma or equivalent.
• 1-3 years prior experience in hospital operations/finance is preferred.
• Analytical skills relevant to cash posting/reconciliation/business or finance/medical terminology is preferred.
• Patient Financial services experience in professional or hospital setting is preferred.

Responsibilities

• Submit insurance claims accurately and follow up on denials.
• Coordinate with internal/external teams to resolve discrepancies.
• Edit claims to comply with submission guidelines.
• Obtain authorizations and referrals for services.
• Research medical records to justify procedures for carriers.
• Submit requested medical information to carriers.
• Analyze and correct patient invoices and accounts for clean submissions.
• Maintain and monitor work queues.
• Respond to third-party correspondence via the system.
• Resolve issues related to payments, denials, and credits.
• Contact patients, physicians, and insurers to obtain needed information.
• Verify claims adjudication using appropriate resources.
• Post payments and denials to invoices in a timely manner.
• Reconcile accounts and resolve posting issues.
• Respond to correspondence promptly and professionally.
• Identify trends and suggest resolution steps to management.
• May maintain data tables for PFS systems.
• Review carrier and departmental information for system tables.
• Read and interpret Explanation of Benefits (EOBs).
• Maintain knowledge of health insurance plans and procedures.
• Document collection activities thoroughly.
• Participate in meetings and trainings to grow knowledge.
• Meet or exceed productivity and quality standards.

Skills

A/R follow-up

Insurance follow-up

Claim denials

Payment posting

Customer service

Education

High school diploma or equivalent

Tools

Document Management System

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.

UNC Health Nash, an affiliated member of the UNC Health system, invites passionate healthcare professionals to join our esteemed team. Governed locally, we proudly serve a diverse patient base, spanning Nash, Edgecombe, Halifax, Wilson Counties, and beyond. With a steadfast commitment to elevating community health through exceptional care, we prioritize excellence, compassion, and innovation, ensuring every individual receives the highest standard of support. Joining our team means becoming an integral part of our dedication to wellness, where we constantly strive to redefine excellence in healthcare through state-of-the-art facilities and pioneering programs. Join us in this transformative journey, where your contributions will make a lasting impact on our community's health and wellbeing.

Summary

The Revenue Cycle Representative is responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims having no response from payers, having claim edits, and/or having received claim form related denials. Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims. Timely resolution of credit balances. Addresses customer issues or concerns related to billing. The Representative performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy under the direction of the Patient Financial Services Manager.

Responsibilities

• 1. Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims.
• 2. Responsible for all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, writeoffs, refunds or other methods.
• 3. Edit claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within scope of authority (or escape as needed) to meet and satisfy billing compliance guidelines for electronic submission.
• 4. Contact insurance carriers to obtain authorizations and referral approvals for services and procedures.
• 5. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
• 6. Submits requested medical information to insurance carrier.
• 7. Responsible for the analysis and necessary corrections of patient invoices or accounts as it pertains to clean claim submissions or re-bills.
• 8. Responsible for maintaining work queues.
• 9. Access, review and respond to third party correspondence via Document Management system.
• 10. 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.
• 11. Contact patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods.
• 12. Verify claims adjudication utilizing appropriate resources and applications.
• 13. Post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner.
• 14. 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.
• 15. Respond to any assigned correspondence in a timely, professional, and complete manner.
• 16. Identify issues and/or trends and provide suggestions for resolution to management, including payer, system or escalated account issues.
• 17. May maintain data tables for systems that support Patient Accounting operations.
• 18. Evaluate carrier and departmental information and determines data to be included in system tables.
• 19. Read and interpret EOB’s (Explanation of Benefits).
• 20. Maintain basic understanding and knowledge of health insurance plans, policies and procedures.
• 21. Accurately and thoroughly document the pertinent collection activity performed.
• 22. Participate and attend meetings, training seminars and in-services to develop job knowledge.
• 23. Meets/Exceeds Productivity and Quality standards.

Other information

• 1. High school diploma or equivalent.
• 2. 1-3 years prior experience in hospital operations/finance is preferred.
• 3. Analytical skills relevant to cash posting/reconciliation/business or finance/medical terminology is preferred.
• 4. Patient Financial services experience in professional or hospital setting is preferred.

Job Details

Legal Employer: Nash Hospitals

Entity: Nash UNC Health Care

Organization Unit: NGH Business Office

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: NASH HC

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.