Revenue Cycle Representative - Physician Ins Billing and Foll
Company: UNC Health Care Systems
Location: Chapel Hill
Posted on: June 7, 2021
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Job Description:
Description 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. Job Summary: 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. Performs all duties in a manner which promotes teamwork and
reflects UNC Health Care's mission and philosophy. Description of Job Responsibilities: 1. Responsible for the accurate and timely submission of claims,
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,
writeoffs, refunds or other methods. 2. Edit 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. 3. Contact insurance carriers to obtain authorizations and
referral approvals for services and procedures. Research medical
records to gather information and substantiate medical
justification for procedures as required by insurance carriers.
Submits requested medical information to insurance carrier. 4. Responsible for the analysis and necessary corrections of
patient invoices or accounts as it pertains to clean claim
submissions or re-bills, and maintaining work queues. Access,
review and respond to third party correspondence via Document
Management system. 5. 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 patients, physicians and insurance companies to
obtain information necessary for invoice or account resolution
through write-offs, reversals, adjustments, refunds or other
methods. 6. Verify claims adjudication utilizing appropriate resources
and applications. Post payments (Insurance and/or Patient) and
denials to patient invoices/accounts in a timely and accurate
manner. 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. 7. 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 Patient Accounting operations. Evaluate
carrier and departmental information and determines data to be
included in system tablesJob Profile This job profile is intended
to provide a representation of responsibilities required. Employees
may be requested to perform job-related tasks other than those
specifically presented in this profile. 8. 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 Education Requirements: High school diploma or GED. Licensure/Certification
Requirements: 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 Other Information Job Details 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 Exempt From Overtime: Exempt: No
Keywords: UNC Health Care Systems, Chapel Hill , Revenue Cycle Representative - Physician Ins Billing and Foll, Other , Chapel Hill, North Carolina
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