REVENUE CYCLE REPRESENTATIVE - PATIENT ACCOUNTING
Company: Shared Services
Posted on: February 16, 2020
This position may involve support of various hospitals and health
care systems within the UNC Health Care System, but will be
employed by Rex Hospital, Inc. (this includes, but is not limited
to, for purposes of payroll, health benefits, retirement options,
and applicable policies). Employees of an entity managed by UNC
Health Care are external candidates and will be employed by Rex
Hospital, Inc. if selected for the role.--
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 Cares mission and philosophy.
Description of Job Responsibilities:
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.
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.
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.
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.
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.
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
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
Read and interpret EOBs (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
Keywords: Shared Services, Raleigh , REVENUE CYCLE REPRESENTATIVE - PATIENT ACCOUNTING, Accounting, Auditing , Raleigh, North Carolina
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