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Job ID: 423
Location: Chapel Hill, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials. Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims. Performs all duties in a manner which promotes teamwork and reflects UNC Health Care’s mission and philosophy. This position will report to the BCBS Team
Description of Job Responsibilities:
• The BCBS team follows up on claims for BCBS of NC, Federal BCBS, the State Health plan and the out of state BCBS plans.
• Responsible for the accurate and timely submission of claims submission and follow up, reconsideration and appeals, response to denials, and re-bills of insurance claims, and all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write-offs, refunds or other methods.
• 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 invoices or accounts and maintaining work queues. Access, review and respond to third party correspondence.
• 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 insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments or other methods.
• Verify claims adjudication utilizing appropriate resources and applications. 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 PB Claims 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.
High School diploma or GED. One (1) year of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections)
Entity: Shared Services
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: Not Applicable