[Hiring] Revenue Cycle Representative @UNC HEALTH

Role Description

May be responsible for performing a variety of complex duties, including but not limited to:

• Working outstanding insurance claims having no response from payors.
• Handling claim edits and/or claim form related denials.
• Maintaining A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims.
• Reviewing credit balances for possible reallocation or refunds.
• Posting payments, contractual adjustments, and denials in a timely, accurate, and complete manner.
• Processing paper correspondence as assigned.

Performs all duties in a manner which promotes teamwork and reflects UNC Health's mission and philosophy.

Qualifications

• High School Degree.
• Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections).

Requirements

• 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.
• Edit claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within scope of authority.
• 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.
• Responsible for the analysis and necessary corrections of patient invoices or accounts.
• Maintain work queues and access, review and respond to third party correspondence via Document Management system.
• 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 patients, physicians and insurance companies to obtain information necessary for invoice or account resolution.
• 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 and resolve a variety of issues.
• Respond to any assigned correspondence in a timely, professional, and complete manner.
• Identify issues and/or trends and provide suggestions for resolution to management.
• May maintain data tables for systems that support Patient Accounting operations.
• Evaluate carrier and departmental information and determine 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.
• Meets/Exceeds Productivity and Quality standards.

Benefits

• Salary Range: $18.48 - $25.89 per hour (Hiring Range).
• Work Type: Full Time.
• Standard Hours Per Week: 40.00.
• Work Assignment Type: Remote.
• Work Schedule: Day Job.
• Location of Job: US:NC:Chapel Hill.
• Exempt From Overtime: Exempt: No.