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Job ID: 5563
Location: Chapel Hill, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
The Revenue Cycle Representative position will report directly to the Non-Governmental Follow-up Manager in Patient Account Services and will be responsible for managing the Commercial and Managed Care Refund correspondence being received from the various payers. The position will be responsible for resolving the refund requests timely, accurately, and efficiently. This also includes working credit balance inventories in EPIC, making out-bound status calls to payers, reviewing payer websites as needed, filing reconsiderations and sending refund denial responses back to the payers. The candidate should be experienced dealing with Managed Care Payers and have substantial knowledge of a variety of carrier policies, procedures and practices. This position requires the ability to analyze claims, payer payments, to determine the need for additional action related to COB, benefit limitations, coverage determination and contract language Performance measured on high production levels, quality of work output in compliance with UHCH policy standards.
Description of Job Responsibilities:
1. Responsible for the accurate and timely submission of claims, 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, writeoffs, refunds or other methods.
2. 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.
3. Contact insurance carriers to obtain authorizations and referral approvals for services and procedures. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers. Submits requested medical information to insurance carrier.
4. Responsible for the analysis and necessary corrections of patient invoices or accounts as it pertains to clean claim submissions or re-bills, and maintaining work queues. Access, review and respond to third party correspondence via Document Management system.
5. 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 patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods.
6. Verify claims adjudication utilizing appropriate resources and applications. Post payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner. 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.
7. 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 Patient Accounting operations. Evaluate carrier and departmental information and determines data to be included in system tables
High school diploma or GED.
No licensure or certification required.
Professional Experience Requirements:
One (1) year of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call Center, or Collections)
At least one (1) year experience in account follow-up for a hospital and/or physician practice.
Knowledge, Skills, and Abilities Requirements:
Good written and verbal communication skills. Intermediate technical skills including PC and MS Outlook. Intermediate knowledge of UB-04, HCFA 1500, and Explanation of Benefits (EOB) interpretation. Intermediate knowledge of insurance collections and insurance terminology. Knowledge of 3rd party reimbursements from insurance companies and government payers is a plus
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.
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.