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Denial Specialist - Physician Insurance Billing and Follow-Up

Job ID: 29712
Location: Chapel Hill, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

The Physician Insurance Billing and Follow Up department ("PB Claims") is looking for seasoned professional billing experts to join our Feedback team. Members of this team report directly to our Feedback Team Supervisor. This role has a high focus on Registration and Insurance and acts as a project manager and subject matter expert for an assigned subset of claims and/or business. Assignments can be based on payor issue type, functional area support type, and Denials, Rejections or edits stemming from Registration issues. This work spans from pre-claims to post-resolution review. To facilitate this, team members must work closely with management and other teams in our department as well as peers on the team, embodying UNC Health's value of One Great Team. The candidate will need to be self-sufficient, organized, and adaptable. Must be able to take clear ownership of assigned work and manage reasonable challenges, in accordance with UNC Health's value of It Starts With Me. The ideal candidate will seek opportunities to improve our process, documentation, and/or system programming - manifesting UNC Health's value of Leading the Way. 

Specific Responsibilities:

  • Registration Review and Analysis: The Feedback Denial Specialist will need to understand how to term, add, research, and fix coverages at registration. They will be responsible for deep dives into identified registration issues, plan research, plan creation and termination, and plan data collection to help determine both system and workflow fixes. The Denial Specialist will be responsible for Maintaining the BOLT Suite of Tableau Dashboards: Generic Insurance Research Dashboard (GIRD) and Plan Research Dashboard (PRD).
  • Reporting and Research: The Denial Specialist will need to know how to run reports in Business Objects and export from both BO and EPIC for the purpose of researching plan volume, plan denials, as well as plan discrepancies. They will also need to understand how to utilize our Clearinghouse, Availity for plan research and understand Electronic Payer Mapping. 
  • EPM/EPP Record Maintenance: Will utilize, understand and maintain EPP/EPM records (via MySupport), in regards to plan information that is key to claim submission, follow-up and maintaining BOLT with up-to-date and accurate information. 
  • Denials Analysis: Denial Specialists will work collaboratively with the PB Policy and Billing Analytics Teams to conduct in-depth analyses of high-dollar claims to identify what is and what is not resulting in the timely and successful resolution of high-dollar claims. 

Other Information

Education Requirements:
● High School diploma or GED
Professional Experience Requirements:
● Three (3) years of experience in a clerical, accounting or customer service setting or an equivalent combination of education, training and experience

● Three years of direct experience working in PB Revenue Cycle, preferably with experience as a team lead or "senior" role. 

● Knowledge of Epic's Resolute Billing Module is strongly preferred and experience with UNC Health’s operational processes is a plus. Coding certification (CPC, etc.) is a plus, though not required. 


Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Physician Ins Billing and Foll 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No



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. This is not a State employed position.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

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