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Job ID: 7909
Location: Raleigh, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
This Revenue Cycle Representative will be a member of the Pre-Services Rex Surgery team. This team is responsible for insurance verification and obtaining authorization for surgery services provided within the UNCHCS. This position is located at the Rex Pre-Arrival Unit. This position interacts will be responsible for performing a variety of complex duties, including but not limited to working with third party insurers via internet & telephone to verify patient insurance and benefits and submit necessary information to obtain authorization for scheduled services. This position interacts with patients, physician offices, financial navigators and clinic staff to ensure accurate information and communicate patient eligibility/authorization status for coordination of services. Successful candidates will be able to work independently, have strong communication skills, well organized with strong attention to detail.
1. Create Hospital and Physician estimates using the Epic Patient Estimator, review eligibility and benefits utilizing RTE, and obtain authorization requirements.
2. Contact patient pre-service providing benefit and patient liability education, explain the estimate cost, and attempt to secure payment and/or set expectation of payment at time of service.
3. Provide estimates to patient shoppers and clinical areas across the healthcare system. Work with clinical areas to create estimate templates, determine workflow and process, and collaborate with ISD for template creation and rollout. Provide payment plans for point-of-service (POS) collections.
4. Train clinical areas on estimate usage and patient scripting for collections, audit and provide feedback on accuracy of estimates utilizing Epic estimate reports. Track and trend collection amounts and template accuracy utilizing hospital and physician EOBs and refine process to enhance accuracy. Screen and assist patients with financial assistance, Medicaid eligibility and/or other funding sources available.
5. Monitor and track routine follow up with Medicaid and financial assistance approvals. Handles HB/PB patient inquiries to address any/all billing questions via inbound calls, MyUNCChart, patient correspondence and patient walk-ins.
6. Fulfills patient requests for itemization of charges, adding/verifying/billing insurance, establishing payment plans, payroll deductions, process adjustments, request refunds, and explain charity care policy and guidelines.
7. Initiate patient outreach on delinquent payment plans, adding accounts to existing payment plans and high risk/balance accounts. Investigate HB and PB Set off Debt Collection Act (SODCA) disputed accounts that have received a NC State Income Tax refund withhold using current and legacy billing and imaging systems. Meets with attorneys to record depositions, collaborate with the attorney general’s office and attend/participate in hearings when needed.
8. Work with Patient Relations, Risk Management for HB and PB patients who have escalated complaints or concerns. Oversee HB Client account billing and follow-up which includes validating charges and fee schedules, review and move charges, research and reconcile payments, communicate with multiple departments to answer client questions and collect payments. Work with external customers such as collection agencies, UNCPN and Hospital based clinics to address any patient concerns
● High school diploma or GED.
Professional Experience Requirements:
● Two (2) years of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections).
Knowledge/Skills/and Abilities Requirements:
● Excellent interpersonal, verbal and written communication skills.
● Excellent listening skills, and organizational skills.
● Advanced knowledge of UB-04, HCFA-1500’s and Explanation of Benefits (EOB) interpretation.
● Intermediate knowledge of CPT and ICD-9 codes.
● Advanced knowledge of insurance billing, collections and insurance terminology.
● Ability to work in fast pace environment and prioritize and manage multiple tasks.
● Healthcare terminology.
● Customer Service skills.
● Computer knowledge: MS Word, Excel, and Outlook.
● Knowledge of 3rd party reimbursements from insurance companies and government payers is a plus.
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Pre-Arrival Unit
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.