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Job ID: 6526
Location: Raleigh, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique 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.
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. Payor Audits & Pro-Active Medical Records Requests: Oversee and document all submissions pertaining to payor-generated pre-payment audits and/or medical records requests.
7. 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.
8. 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.
9. 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.
10. 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.
● No licensure or certification required.
Professional Experience Requirements:
● Three (3) years of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections).
Knowledge/Skills/and Abilities Requirements:
● Excellent written and verbal communication skills.
● Intermediate technical skills including PC and MS Outlook.
● Advanced knowledge of Explanation of Benefits (EOB) and EITHER or BOTH the UB-04 for Hospital Billing or the HCFA 1500 for Professional Billing
● Intermediate knowledge of CPT and ICD-10 codes.
● Advanced knowledge of insurance billing, collections and insurance terminology.
● Extensive knowledge of 3rd party reimbursements from insurance companies and government payers is a plus.
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Patient Accounting
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Raleigh
Exempt From Overtime: Exempt: No
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.