Revenue Cycle Representative - Patient Accounting

About the role

May be responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims having no response from payors, having claim edits, and/or having received claim form related denials. Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims. Review credit balances for possible reallocation or refunds. May be responsible for posting payments, contractual adjustments, and denials in a timely, accurate, and complete manner. Process paper correspondence as assigned. Performs all duties in a manner which promotes teamwork and reflects UNC Health's mission and philosophy.

Responsibilities

• Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims
• Responsible for all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, writeoffs, refunds or other methods
• Edit claims (DNB, Coverage Changes, Claim Edits, Stop Bills) within scope of authority (or escalate as needed) to meet and satisfy billing compliance guidelines for electronic submission
• Contact insurance carriers to obtain authorizations and referral approvals for services and procedures
• 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 patient invoices or accounts as it pertains to clean claim submissions or re-bills
• Responsible for maintaining work queues
• Access, review and respond to third party correspondence via Document Management system
• 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 patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods
• Verify claims adjudication utilizing appropriate resources and applications
• Post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner
• 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 Patient Accounting 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

Qualifications

• High School Degree
• Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections)

Pay

$18.48 - $25.89 per hour (Hiring Range). Pay offers are determined by experience and internal equity.

Schedule

Full Time (40 hours per week), Day Job, Remote work assignment.