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Patient Accounting Specialist
2 months ago
Become a vital part of an inclusive organization with over 40,000 diverse employees, dedicated to enhancing the health and well-being of the unique communities we serve.
Position Overview:
The Revenue Cycle Representative is tasked with a variety of intricate responsibilities, including managing outstanding insurance claims that lack responses from payors, addressing claim edits, and resolving claim form-related denials. This role is essential in maintaining accounts receivable at acceptable aging levels through prompt follow-up on unpaid and denied claims. Additionally, the representative will review credit balances for potential reallocations or refunds and may be responsible for accurately posting payments, contractual adjustments, and denials in a timely manner. All duties should be performed in a manner that fosters teamwork and aligns with UNC Health's mission and philosophy.
This position is remote and involves collaboration with a team of eight.
Key Responsibilities:
Reporting to the Medicare Supervisor, the primary focus of the Revenue Cycle Representative is the effective management of Medicare accounts receivable through the precise and timely submission of primary, secondary, and tertiary claims to ensure maximum resolution and reimbursement.
Key duties include:
- Accurate and timely submission of claims, addressing denials, and re-billing insurance claims.
- Comprehensive follow-up and collections related to insurance, collaborating with internal and external departments to resolve discrepancies through charge corrections, payment adjustments, write-offs, refunds, or other necessary methods.
- Editing claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within the scope of authority to meet billing compliance guidelines for electronic submissions.
- Contacting insurance carriers to secure authorizations and referral approvals for services and procedures.
- Researching medical records to gather necessary information and substantiate medical justification for procedures as required by insurance carriers.
- Submitting requested medical information to insurance carriers.
- Analyzing and correcting patient invoices or accounts to ensure clean claim submissions or re-bills.
- Maintaining work queues and responding to third-party correspondence via the Document Management system.
- Researching and resolving issues related to payment postings, insurance denials, secondary billing, credit balances, and non-payment of claims.
- Engaging with patients, physicians, and insurance companies to gather information necessary for invoice or account resolution.
- Verifying claims adjudication using appropriate resources and applications.
- Posting payments (Insurance and/or Patient) and denials to patient invoices/accounts accurately and promptly.
- Reconciling accounts and addressing various issues related to payment postings and insurance claims.
- Responding to assigned correspondence in a timely and professional manner.
- Identifying issues and trends, providing suggestions for resolution to management.
- Maintaining data tables for systems supporting Patient Accounting operations.
- Reading and interpreting EOBs (Explanation of Benefits).
- Keeping a basic understanding of health insurance plans, policies, and procedures.
- Documenting collection activities thoroughly and accurately.
- Participating in meetings, training seminars, and in-services to enhance job knowledge.
- Meeting or exceeding 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)
Knowledge, Skills, and Abilities:
Successful candidates will demonstrate a strong understanding of the healthcare revenue cycle, possess excellent communication skills, and have the ability to work collaboratively in a remote environment.
