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Revenue Cycle Representative

Job ID: 50915
Location: Smithfield, NC
Facility/Division: Johnston Health
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 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

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:

  1. Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims.
  2. 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.
  3. 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.
  4. Contact insurance carriers to obtain authorizations and referral approvals for services and procedures.
  5. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
  6. Submits requested medical information to insurance carrier.
  7. Responsible for the analysis and necessary corrections of patient invoices or accounts as it pertains to clean claim submissions or re-bills.
  8. Responsible for maintaining work queues.
  9. Access, review and respond to third party correspondence via Document Management system.
  10. 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.
  11. Contact patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods.
  12. Verify claims adjudication utilizing appropriate resources and applications.
  13. Post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner.
  14. 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.
  15. Respond to any assigned correspondence in a timely, professional, and complete manner.
  16. Identify issues and/or trends and provide suggestions for resolution to management, including payer, system or escalated account issues.
  17. May maintain data tables for systems that support Patient Accounting operations.
  18. Evaluate carrier and departmental information and determines data to be included in system tables.
  19. Read and interpret EOB’s (Explanation of Benefits).
  20. Maintain basic understanding and knowledge of health insurance plans, policies and procedures.
  21. Accurately and thoroughly document the pertinent collection activity performed.
  22. Participate and attend meetings, training seminars and in-services to develop job knowledge.
  23. Meets/Exceeds Productivity and Quality standards.

Other Information

Other information:
Education Requirements:
● High School Degree
Licensure/Certification Requirements:
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:


Job Details

Legal Employer: NCHEALTH

Entity: Johnston Health

Organization Unit: Business Office

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Smithfield

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 Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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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.

Equal Employment Opportunity

UNC Health is an equal opportunity and affirmative action employer.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

All interested applicants are invited to apply for career opportunities. Please refer to our Employment Application Accessibility page if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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Learn further E-Verify details in E-Verify (English) or E-Verify (Spanish).

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