Revenue Cycle Representative II

Jefferson Health Plans; United States; Remote; USD 52,000 - 73,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plans

Job summary

Jefferson Health Plans is seeking a Revenue Cycle Representative II to review and resolve complex claim denials by coordinating with payers, hospital departments and patients. The role emphasizes appeals research, rebilling, and balance transfers to the next responsible party.

Ideal candidates have 3+ years in hospital revenue cycle, familiarity with insurance plans, and proficiency in Epic and Microsoft Office. This remote, US-based position supports a national network.

Qualifications

• 3+ years of experience in hospital revenue cycle
• Experience with insurance plans and contract language is preferred
• Experience with Epic is preferred and Microsoft Office proficiency

Responsibilities

• Interacts with payers, hospital departments and patients to resolve denials.
• Develops appeals strategies including authorization research and rebilling.
• Communicates with third party payers and departments to obtain denial information.
• Maintains understanding of third party regulations for appeals and follow-up.
• Works independently to meet department productivity and quality standards

Skills

Payer communications

Denial appeals

Independence

Customer service

Communication

Education

High School Diploma/GED

Associates or Bachelors degree preferred

Tools

Epic

Microsoft Office

Job description

Number of Positions In Requisition

2

Job Details

Revenue Cycle Representative II

Job Description

Revenue Cycle Representative II is responsible for reviewing, analyzing and initiating appropriate action for complex case claim denial resolution by communicating with payers, hospital departments and patients.

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Completes appropriate strategy for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer for next responsible party.
• Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution.
• Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites or contact as needed.
• Maintains understanding of third party regulations for appeals and appeal follow-up.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Competencies (Knowledge, Skills, and Abilities Required):

Communicate with patients, insurance carriers, physician’s offices, and other hospital departments in a courteous and professional manner.

Maintains productivity and quality requirements as defined by department policy.

Demonstrated ability to work independently with minimal supervision.

Other duties as assigned by supervisor.

Minimum Education and Experience Requirements:

Education:

High School Diploma/GED required

Associates or Bachelors degree preferred

AND

Experience:

Minimum 3 years of experience working in hospital revenue cycle

Working knowledge of insurance plans and contract language

Computer skills, including proficiency in Windows 10 and Microsoft Office

Knowledge of State and Federal healthcare billing and coding guidelines.

Experience working with Epic preferred.

Work from home

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Albert Einstein Medical Center

Primary Location Address

60 Township Line Road, Elkins Park, 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 provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time(including per diemcolleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

For more benefits information, please click here