Billing and Collections Specialist

4 weeks ago

SaintAubinsurGaillon, Normandie, United States UNC Health Care Full time
Job Description

Overview

Join a diverse team dedicated to enhancing the health and wellness of the communities we serve.

Position Summary:

This role involves executing a range of intricate tasks, including managing unresolved insurance claims, addressing claim edits, and handling denials related to claim forms. The incumbent will ensure that accounts receivable remains within acceptable aging levels through timely follow-up on unpaid and denied claims. Additionally, responsibilities include reviewing credit balances for potential reallocations or refunds. The role may also encompass the accurate and prompt posting of payments, contractual adjustments, and denials. All duties should be performed in a manner that fosters teamwork and aligns with the mission and philosophy of UNC Health Care.

Key Responsibilities:

  • Ensure the precise and timely submission of claims, address denials, and manage re-billing of insurance claims. Oversee all aspects of insurance follow-up and collections, collaborating with internal and external departments to resolve discrepancies through charge corrections, payment adjustments, write-offs, refunds, or other methods. Edit claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within the scope of authority, or escalate as necessary, to comply with billing guidelines for electronic submissions. Communicate with insurance carriers to secure authorizations and referral approvals for services and procedures. Investigate medical records to gather necessary information and substantiate medical justification for procedures as required by insurance providers. Submit requested medical documentation to insurance carriers.
  • Analyze and correct patient invoices or accounts to ensure clean claim submissions or re-bills. Maintain work queues and access, review, and respond to third-party correspondence via the Document Management system. Research and resolve various issues related to payment postings, insurance denials, secondary billing concerns, credit balances, charge sequencing, and claims non-payment. Engage with patients, physicians, and insurance companies to gather information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds, or other methods. Verify claims adjudication using appropriate resources and applications. Accurately post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely manner.
  • Reconcile accounts and investigate various issues related to payment postings and charges, insurance denials, secondary billing matters, charge sequencing, and claims non-payment. Respond to assigned correspondence in a timely, professional, and thorough manner. Identify issues and trends, providing management with suggestions for resolution, including payer, system, or escalated account issues. May maintain data tables for systems supporting Patient Accounting operations. Evaluate carrier and departmental information to determine data inclusion in system tables. Read and interpret EOBs (Explanation of Benefits).
  • Maintain a foundational understanding of health insurance plans, policies, and procedures. Document collection activities accurately and thoroughly. Participate in meetings, training seminars, and in-services to enhance job knowledge. Meet or exceed productivity and quality standards.
Additional Information

Education Requirements:
* High School Diploma
Professional Experience Requirements:
* Minimum of two (2) years of experience in hospital or physician insurance-related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections)

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Pre-Arrival Unit

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $24.63 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

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.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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.

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