Revenue Cycle Representative Senior- Patient Accounting
Company: UNC Health Care
Location: Morrisville
Posted on: March 10, 2025
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Job Description:
Description Become part of an inclusive organization with over
40,000 teammates, whose mission is to improve the health and
well-being of the unique communities we serve.Summary:Responsible
for performing a variety of complex duties in support of
reimbursement from patient and insurance carriers throughout the
revenue cycle from pre-service with prior authorizations and
insurance verification to post-service with billing, follow-up and
collections. Requires substantial knowledge of all carrier
policies, procedures and practices necessary to collect carrier
accounts receivable and resolve denials. Participates and assists
in special projects. Assists new or existing staff with training or
techniques to increase production and quality as well as provide
support for the team members that may be absent or backlogged.
Perform all duties in a manner which promotes teamwork and reflects
UNC Health Care's mission and philosophy.Responsibilities:1.
Appeals & Managed Care Escalations: Project Manage all 3rd party
appeals including researching and determining if carrier denial of
claim is valid and if not, abstracts information from medical
records to support appeal of denial. Works in conjunction with
appropriate resources (Coding, HIM or clinicians) to ensure that
appeal is effective and is responsible for performing charge
corrections / coding changes in accordance with all (internal and
external) regulatory and coding guidelines/policies. Facilitate
monthly Provider Calls and Managed Care Escalations.2. Training &
Backup: Supports management in onboarding new hires and providing
technical support to existing staff to ensure that time to
productivity is minimal and quality is optimal. Will be available
to step in to alleviate any operational impacts associated with
turnover or other staffing-related issues.3. Patient & Provider
Follow-up: Will review, resolve and if necessary escalate to
management patient-level issues stemming from contested charges,
Risk Management or Patient Relations.4. Reviews Cosmetic & Elective
account agreements to ensure accurate postings and processing by
carriers. Troubleshoots self-pay payment issues including credit
card charge-back notices and NSF checks.5. Credit Management:
Performs complex remit processing (PLB's, FB's, WO's) and serves as
back-up to input deposits into cash databases. Reviews and
processes insurance credits to resolve credit balances through
refunds or posting adjustments. Compiles Medicare/Medicaid Cash
Reports and quarterly Credit Balance reports.6. Payor Audits &
Pro-Active Medical Records Requests: Oversee and document all
submissions pertaining to payor-generated pre-payment audits and/or
medical records requests.7. AR Reduction & Quality Review Projects:
Identifies and project manages higher-level AR Reduction projects.
Assists management with quality audits including reviewing and
approving adjustment requests at their approved level.8. Analysis:
Uses available reporting tools to analyze, trend/quantify and if
necessary escalate to appropriate stakeholders to drive
improvements in preventing denials or resolving aging accounts.9.
Research & Transplant: performs charge reviews, follow-up and
payment allocations for HB & PB Transplant Services. Reviews and
corrects billing issues with Research Accounts to ensure proper
billing.10. Other: Responsible for processing Part B split claims.
Accurately and thoroughly document the pertinent collection or
follow-up activity performed. Meets/Exceeds Productivity & Quality
Standards. Escalates issues to senior team members and/or
management those issues impacting successful account
resolution.Other InformationOther information:Education
Requirements:--- High school diploma or GED.Licensure/Certification
Requirements:--- No licensure or certification
required.Professional Experience Requirements:--- Three (3) years
of experience in Hospital or Physician Insurance related activities
(Authorization, Billing, Follow-Up, Call-Center, or
Collections).Knowledge/Skills/and Abilities Requirements:---
Excellent written and verbal communication skills.--- Intermediate
technical skills including PC and MS Outlook.--- Advanced knowledge
of Explanation of Benefits (EOB) and EITHER or BOTH the UB-04 for
Hospital Billing or the HCFA 1500 for Professional Billing---
Intermediate knowledge of CPT and ICD-10 codes.--- Advanced
knowledge of insurance billing, collections and insurance
terminology.--- Extensive knowledge of 3rd party reimbursements
from insurance companies and government payers is a plus.Job
DetailsLegal Employer: NCHEALTHEntity: Shared ServicesOrganization
Unit: Patient Accounting Work Type: Full TimeStandard Hours Per
Week: 40.00Salary Range: -$19.59 - $27.84 per hour (Hiring
Range)Pay offers are determined by experience and internal
equityWork Assignment Type: RemoteWork Schedule: Day JobLocation of
Job: US:NC:MorrisvilleExempt From Overtime: Exempt: NoThis position
is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a
private, fully-owned subsidiary of UNC Health Care System, in a
department that provides shared services to operations across UNC
Health Care; except that, if you are currently a UNCHCS State
employee already working in a designated shared services
department, you may remain a UNCHCS State employee if selected for
this job.Qualified applicants will be considered without regard to
their race, color, religion, sex, sexual orientation, gender
identity, national origin, disability, or status as a protected
veteran.UNC Health makes reasonable accommodations for applicants'
and employees' religious practices and beliefs, as well as
applicants and employees with disabilities. All interested
applicants are invited to apply for career opportunities. Please
email applicant.accommodations@unchealth.unc.edu if you need a
reasonable accommodation to search and/or to apply for a career
opportunity.
Keywords: UNC Health Care, Cary , Revenue Cycle Representative Senior- Patient Accounting, Accounting, Auditing , Morrisville, North Carolina
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