- 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.
- 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.
- Responsible for 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 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 Patient Accounting 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 equivalent.
- Analytical skills relevant to cash posting/reconciliation/business or finance/medical terminology is preferred.
- Patient Financial services experience in professional or hospital setting is preferred.
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Revenue Cycle Representative - Rocky Mount, United States - UNC Health Care Systems
Description
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.
Summary:
The Revenue Cycle Representative is responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims having no response from payers, having claim edits, and/or having received claim form related denials.
The Representative performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy under the direction of the Patient Financial Services Manager.
Responsibilities:
Other information:
Legal Employer:
Nash Hospitals
Entity:
Nash UNC Health Care
Organization Unit:
NGH Business Office
Work Type:
Full Time
Standard Hours Per Week: 40.00
Work Assignment Type:
Hybrid
Work Schedule:
Day Job
Location of Job:
NASH HC
Exempt From Overtime:
Exempt: No
