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Job ID: 7507
Location: Chapel Hill, 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.
The Physician Insurance Billing and Follow Up department is looking for seasoned professional billing experts to join our Follow up Team in a Denial Specialist role working as part of PB Payor Escalation Team. Members of this team will report directly to our department's PB Claims Operations Manager.
This Payor Escalation Denial Specialist acts as a project manager for an assigned subset of claims and/or business related to Payor Escalations. This work spans from claims follow-up to post-escalation review. To facilitate this, the Denial Specialist must work closely with management, payor teams and other teams in our department. Candidate must be adaptable and willing to work across various Managed Care Payors.
Specific Responsibilities of the Denial Specialist:
Payor Issues Analyses: Work collaboratively with Management, PB Payor Teams, Coding and the Managed Care team in reviewing claims denial issues reported in our Payors Issues Notebook (PIN). This role will be assisting in reviewing denied PB Claims that need to be submitted to the Managed Care payor for escalation review. Review Managed Care payor policies, utilize Coding Editing Tools and claims data to determine if the claim is eligible to be sent to the payor for escalation. The Denial Specialist will assist in managing this population of AR. Use of Business Objects, Tableau Dashboards and Excel for further claims analysis as needed.
AR Management: Assist with management of claims within Payor Team WQ's related to PIN items and Managed Care Escalations. Review escalation spreadsheets prior to submitting to the payor, ensure claims are moved to the appropriate WQ and document in Epic. The Denial Specialist will review spreadsheets that are returned from the payor, review the claims in Epic to ensure payments are applied and document payor responses. Review upheld denials and determine appropriate next action of Coding Review, Appeal or Adjustment.
AdHoc Support: Provide support to bridge gaps in staffing or act as a liaison between the PB Follow-up team and it's peer groups by managing specific types of inter-departmental work. Assignments can be based on dollar threshold, payor issue type, functional area support type, or complexity of individual patient accounts.
● High School diploma or GED
● No licensure or certification required.
Professional Experience Requirements:
Three (3) years of experience in a clerical, accounting or customer service setting or an equivalent combination of education, training and experience
3 years of direct experience working in PB Revenue Cycle. Knowledge of Epic's Resolute Billing Module is extremely preferred and experience with UNC Health operational processes is a plus. Prior experience working with Managed Care Payors, Payor Policies and Business Objects preferred.
The ideal candidate will need to be self-sufficient, organized, and adaptable.
Knowledge/Skills/and Abilities Requirements:
Legal Employer: NC Health
Entity: Shared Services
Organization Unit: Physician Ins Billing and Foll
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: 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.