Revenue Cycle Specialist
1 month ago
We are seeking a skilled Revenue Cycle Representative to join our team at UNC Health. As a key member of our revenue cycle team, you will be responsible for performing a variety of complex duties, including working outstanding insurance claims follow up, claim denials, and maintaining accurate and timely submission of claims follow up, reconsideration and appeals.
Key Responsibilities:
- Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals, response to denials, and re-bills of insurance claims.
- 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 invoices or accounts and maintaining work queues.
- Access, review and respond to third party correspondence.
- 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 insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments or other methods.
- Verify claims adjudication utilizing appropriate resources and applications.
- Reconcile accounts, research and resolve a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims.
- Respond to any assigned correspondence in a timely, professional, and complete manner.
- Identify issues and/or trends and provide suggestions for resolution to management, including payer, system or escalated account issues.
- May maintain data tables for systems that support PB Claims operations.
- Evaluate carrier and departmental information and determines 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.
Requirements:
- High School Degree
- Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections)
Work Environment:
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 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. Please email [email address] if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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