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Job ID: 10588
Location: Chapel Hill, 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.
May be responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims having no response from payors, having claim edits, and/or having received claim form related denials. Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims. Reviews credit balances for possible reallocation or refunds. May be responsible for posting payments, contractual adjustments, and denials in a timely, accurate, and complete manner. Processes paper correspondence as assigned. Performs all duties in a manner which promotes teamwork and reflects UNC Health’s mission and philosophy.
-Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims. Responsible for 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. Edits 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. Contacts insurance carriers to obtain authorizations and referral approvals for services and procedures. Researches 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 patient invoices or accounts as it pertains to clean claim submissions or re-bills. Responsible for maintaining work queues. Accesses, reviews and responds to third party correspondence via Document Management system. Researches and resolves 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. Contacts patients, physicians and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods. Verifies claims adjudication utilizing appropriate resources and applications. Posts payments (Insurance and/or Patient) and denials to patient invoices/accounts in a timely and accurate manner.
-Reconciles accounts, researches and resolves a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims. Responds to any assigned correspondence in a timely, professional, and complete manner. Identifies issues and/or trends and provides suggestions for resolution to management, including payer, system or escalated account issues. May maintain data tables for systems that support Patient Accounting operations. Evaluates carrier and departmental information and determines data to be included in system tables. Reads and interprets EOB’s (Explanation of Benefits).
-Maintains basic understanding and knowledge of health insurance plans, policies and procedures. Accurately and thoroughly documents the pertinent collection activity performed. Participates and attends meetings, training seminars and in-services to develop job knowledge. Meets/Exceeds Productivity and Quality standards
● High School Degree
Professional Experience Requirements:
● Two (2) years of experience in hospital or physician insurance related activities ((Authorization, Billing, Follow-Up, Call-Center, or Collections
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Cash Management
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.