Revenue Cycle Representative

Revenue Cycle Representative

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

Job Summary:

Responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no authorization post claim. Maintains A/R at acceptable aging levels by prompt follow-up of denied claims. Performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy. This position will report to the PB Authorization Denials Supervisor.

Description of 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 and submit reconsiderations or appeals necessary to overturn authorization denials. Submits requested medical information to insurance carrier as requested.

Responsible for the analysis and necessary corrections of invoices or accounts and maintaining work queues. Access, review and respond to third party correspondence. Navigate websites as it relates to authorizations.

Research and resolve a variety of authorization issues which can include understanding of insurance guidelines surrounding authorizations and referrals, i.e., navigating PPA lists. Contact insurance companies to verify authorizations on file and authorization policies and submit retro authorization.

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.

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: