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Insurance Revenue Specialist
3 months ago
Position Summary
Become an integral part of a diverse organization dedicated to enhancing the health and wellness of the unique communities we serve.
Role Summary:
This position emphasizes Registration and Insurance processes. The selected candidates will undertake a variety of intricate tasks, including but not limited to, verifying and updating patient registration details, contacting insurance providers to gather policy information, addressing outstanding insurance claims with no responses from payors, and resolving claim edits or rejections stemming from registration inaccuracies. Candidates will be responsible for maintaining accounts receivable at acceptable aging levels by effectively managing assigned work queues. It is essential that candidates perform all responsibilities in a manner that fosters collaboration and aligns with the mission and values of UNC Health. Candidates should exhibit self-sufficiency, organizational skills, and adaptability, taking ownership of their assigned tasks and navigating challenges in accordance with the principle of personal accountability.
Key Responsibilities:
- Registration Review and Analysis: Understand how to term, add, research, and rectify coverages at registration, and edit claims (Coverage Changes, Registration updates, and Claim Edits) within the scope of authority, or escalate as necessary to comply with billing standards for electronic submissions. Responsible for analyzing and correcting patient invoices or accounts to ensure clean claim submissions or re-bills. Maintain a foundational understanding of health insurance plans, policies, and procedures.
- Insurance Research: Engage with insurance carriers to obtain patient eligibility and claim submission details. Investigate medical records to gather information pertinent to Workers Compensation claims and billing. Research various issues related to payment postings, insurance denials, secondary billing challenges, credit balances, charge sequencing, and claim non-payments. Communicate with patients, healthcare providers, and insurance companies to gather necessary information for invoice or account resolution. Verify claims adjudication using appropriate resources and applications. Interpret EOBs (Explanation of Benefits).
- Reporting and Issue Resolution: Identify trends and issues, providing management with suggestions for resolution, including payer, system, or escalated account challenges. Evaluate carrier and departmental data to determine relevant information for system tables.
- Production and Quality Standards: Candidates are expected to meet and uphold production and quality benchmarks. Responsible for managing work queues and accurately documenting relevant collection activities. Participate in meetings, training sessions, and in-services to enhance job knowledge.
Education Requirements:
* High School Diploma
Licensure/Certification Requirements:
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:
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Physician Insurance Billing and Follow-Up
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $24.63 per hour (Hiring Range)
Work Assignment Type: Hybrid
Work Schedule: Day Job
Exempt From Overtime: 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 accommodates applicants' and employees' religious practices and beliefs, as well as those with disabilities. All interested applicants are encouraged to explore career opportunities.
