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** Due to the recent switch in our HR and application systems, our HR team is working hard towards implementing a new and improved, mobile friendly Employee Referral solution expected to launch this summer. For applicable positions and referral guidelines, learn more here.
After reviewing the referral guidelines, in the interim, we ask that you submit your employee referral by filling out this form. Please ensure that you submit your referral before your referral has applied to the position. Thank you for your patience during this transition.
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Job ID: 7482
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.
Remote work available due to Covid-19
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 one of the following teams:
Medicare, Hospice, and Skilled Nursing Facility (SNF) Follow-Up Team
Medicare Advantage Follow-Up Team
Medicaid Follow-Up Team
BCBS Follow-Up Team
Commercial Follow-Up Team
Workers Comp, CQT, and Documentation Team
Payor Edits and Rejections (Pre-Claims Team)
Registration Edits and Agency Follow-Up Team
Description of Job Responsibilities:
• 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.
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) 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
Legal Employer: NCHEALTH
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 (Position is remote due to Covid-19).
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.