Revenue Cycle Representative - Patient Accounting

UNC Health Care; Eastowne (NC); Remote; USD 100,000 - 125,000; Full time

Job summary

A prominent healthcare organization is seeking an Insurance Claims Specialist to handle insurance claims, follows up on unpaid claims, and maintains accurate records. The role requires a high school degree and two years of relevant experience. This is a full-time position with a salary range of $17.94 - $25.25 per hour, where you can work remotely.

Qualifications

• Two years of experience in hospital or physician insurance-related activities.

Responsibilities

• Submit claims and respond to denials.
• Ensure timely follow-up on insurance claims.
• Edit claims to meet billing compliance.
• Research medical records for justification.
• Analyze and correct patient invoices.

Skills

Claim submission

Insurance follow-up

Medical records research

Problem resolution

Education

High School Degree

Job description

Overview

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.

Summary: May be responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims having no response from payors, claim edits, and/or claim form related denials. Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims. Review credit balances for possible reallocation or refunds. May be responsible for posting payments, contractual adjustments, and denials in a timely, accurate, and complete manner. Process paper correspondence as assigned. Performs all duties in a manner which promotes teamwork and reflects UNC Health\'s mission and philosophy.

Responsibilities

• Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims.
• 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.
• Edit claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within scope of authority (or escalate as needed) to meet and satisfy billing compliance guidelines for electronic submission.
• 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. Submit requested medical information to insurance carrier.
• Analyze and correct patient invoices or accounts as it pertains to clean claim submissions or re-bills. Maintain work queues. Review third party correspondence via Document Management system.
• Research and resolve issues related to posting of payments and charges, insurance denials, secondary billing, credit balances, sequencing of charges, and non-payment of claims. Contact patients, physicians and insurance companies to obtain information for resolution through write-offs, reversals, adjustments, refunds or other methods.
• Verify claims adjudication using appropriate resources and post payments (Insurance and/or Patient) and denials to invoices/accounts in a timely and accurate manner.
• Reconcile accounts and respond to assigned correspondence professionally and promptly. Identify issues or trends and provide suggestions for resolution to management. May maintain data tables for systems supporting Patient Accounting operations and interpret EOBs.
• Maintain basic understanding of health insurance plans, policies and procedures; document collection activity; participate in meetings and training; meet or exceed Productivity and Quality standards.

Qualifications

• 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: Patient Accounting
• Work Type: Full Time
• Standard Hours Per Week: 40.00
• Salary Range: $17.94 - $25.25 per hour (Hiring Range)
• Pay offers: determined by experience and internal equity
• Work Assignment Type: Remote
• 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. If you are currently a UNCHCS State employee 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 apply for a career opportunity.