Rev Cycle Representative II

Revenue Cycle Representative II

Responsible for reviewing, analyzing and initiating appropriate action for complex case claim denial resolution by communicating with payers, hospital departments and patients.

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Completes appropriate strategy for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer for next responsible party.
• Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution.
• Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites or contact as needed.
• Maintains understanding of third party regulations for appeals and appeal follow-up.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Competencies:

Communicate with patients, insurance carriers, physician's offices, and other hospital departments in a courteous and professional manner.

Maintains productivity and quality requirements as defined by department policy.

Demonstrated ability to work independently with minimal supervision.

Other duties as assigned by supervisor.

Minimum Education and Experience Requirements:

Education:

High School Diploma/GED required

Associates or Bachelors degree preferred

AND

Experience:

Minimum 3 years of experience working in hospital revenue cycle

Working knowledge of insurance plans and contract language

Computer skills, including proficiency in Windows 10 and Microsoft Office

Knowledge of State and Federal healthcare billing and coding guidelines.

Experience working with Epic preferred.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Abington Memorial Hospital

Primary Location Address

2500 Maryland Road, Willow Grove, Pennsylvania, United States of America