Revenue Cycle Representative - Patient Accounting

UNC REX Healthcare; Eastowne (NC); Remote; USD 100,000 - 125,000; Full time

Job summary

A healthcare organization is seeking an experienced claims specialist to manage insurance submissions and follow-ups. Candidates should have a high school degree and at least two years of relevant experience in hospital billing and insurance activities. The position allows for remote work, maintaining a focus on teamwork and communication. This role provides a salary range of $17.94 - $25.25 per hour based on experience.

Benefits

Flexible work schedule

Professional development opportunities

Health benefits

Qualifications

• At least two years of experience in hospital or physician insurance activities.
• Familiarity with health insurance plans and policies.
• Ability to analyze and correct patient invoices.

Responsibilities

• Submit claims and respond to denials in a timely manner.
• Follow up on unpaid claims through internal and external communication.
• Research issues related to payments and insurance denials.

Skills

Insurance claim processing

Communication skills

Problem-solving

Education

High School Degree

Tools

Document Management System

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, 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. 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. Submits 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. Access, review and respond to third party correspondence via Document Management system.
• Research and resolve issues relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims.
• Contact patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods. Verify claims adjudication utilizing appropriate resources and applications. Post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner.
• Reconcile accounts and research/resolve issues related to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims.
• Respond to assigned correspondence in a timely, professional, and complete manner. Identify issues or trends and provide suggestions for resolution to management, including payer, system or escalated account issues.
• May maintain data tables for systems that support Patient Accounting operations. Evaluate carrier and departmental information to determine data to be included in system tables. Read and interpret EOBs (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 in meetings, training seminars and in-services to develop job knowledge. Meets/Exceeds 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: Patient Accounting

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $17.94 - $25.25 per hour (Hiring Range)

Pay offers are 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; 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.