Revenue Cycle Representative

Revenue Cycle Representative

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

• Responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials.
• Works physician claims ("professional billing").
• Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims.
• Performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy.

Job Responsibilities:

• Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals, response to denials, and re-bills of insurance claims, and all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write-offs, other methods.
• Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
• Submit 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.
• Meet/Exceed Productivity and Quality standards.

Education Requirements: High School Degree

Licensure/Certification Requirements: None

Professional Experience Requirements: Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections)

Knowledge/Skills/and Abilities Requirements: