Revenue Cycle Representative

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:
The Revenue Cycle Representative is responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims having no response from payers, 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. Timely resolution of credit balances. Addresses customer issues or concerns related to billing. The Representative performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy under the direction of the Patient Financial Services Manager.

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:
1. High school diploma or equivalent.
2. 1-3 years prior experience in hospital operations/finance is preferred.
3. Analytical skills relevant to cash posting/reconciliation/business or finance/medical terminology is preferred.
4. Patient Financial services experience in professional or hospital setting is preferred.

Job Details

Legal Employer: Nash Hospitals

Entity: Nash UNC Health Care

Organization Unit: NGH Business Office

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: NASH HC

Exempt From Overtime: Exempt: No