Joining UNC Health Care system means you’ll become part of an inclusive organization with a mission to improve the health and well-being of the diverse communities we serve.
Responsible for performing a variety of complex duties in support of reimbursement from patient and insurance carriers throughout the revenue cycle from pre-service with prior authorizations and insurance verification to post-service with billing, follow-up and collections. Requires substantial knowledge of all carrier policies, procedures and practices necessary to collect carrier accounts receivable and resolve denials. Participates and assists in special projects. Assists new or existing staff with training or techniques to increase production and quality as well as provide support for the team members that may be absent or backlogged. Perform all duties in a manner which promotes teamwork and reflects UNC Health Care’s mission and philosophy.
Description of Job Responsibilities:
• Appeals & Managed Care Escalations: Project Manage all 3rd party appeals including researching and determining if carrier denial of claim is valid and if not, abstracts information from medical records to support appeal of denial. Works in conjunction with appropriate resources (Coding, HIM or clinicians) to ensure that appeal is effective and is responsible for performing charge corrections / coding changes in accordance with all (internal and external) regulatory and coding guidelines/policies. Facilitate monthly Provider Calls and Managed Care Escalations.
• Training & Backup: Supports management in onboarding new hires and providing technical support to existing staff to ensure that time to productivity is minimal and quality is optimal. Will be available to step in to alleviate any operational impacts associated with turnover or other staffing-related issues.
• Patient & Provider Follow-up: Will review, resolve and if necessary escalate to management patient-level issues stemming from contested charges, Risk Management or Patient Relations.
• Reviews Cosmetic & Elective account agreements to ensure accurate postings and processing by carriers. Troubleshoots self-pay payment issues including credit card charge-back notices and NSF checks.
• Credit Management: Performs complex remit processing (PLB’s, FB’s, WO’s) and serves as back-up to input deposits into cash databases. Reviews and processes insurance credits to resolve credit balances through refunds or posting adjustments. Compiles Medicare/Medicaid Cash Reports and quarterly Credit Balance reports.
• Payor Audits & Pro-Active Medical Records Requests: Oversee and document all submissions pertaining to payor-generated pre-payment audits and/or medical records requests.
• AR Reduction & Quality Review Projects: Identifies and project manages higher-level AR Reduction projects. Assists management with quality audits including reviewing and approving adjustment requests at their approved level.
• Analysis: Uses available reporting tools to analyze, trend/quantify and if necessary escalate to appropriate stakeholders to drive improvements in preventing denials or resolving aging accounts.
• Research & Transplant: performs charge reviews, follow-up and payment allocations for HB & PB Transplant Services. Reviews and corrects billing issues with Research Accounts to ensure proper billing.
• Other: Responsible for processing Part B split claims. Accurately and thoroughly document the pertinent collection or follow-up activity performed. Meets/Exceeds Productivity & Quality Standards. Escalates issues to senior team members and/or management those issues impacting successful account resolution.
High School diploma or GED. Three (3) years of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections).