Revenue Cycle Representative Senior - Customer Service Call Center

Revenue Cycle Representative Senior - Customer Service Call Center

Join to apply for the Revenue Cycle Representative Senior - Customer Service Call Center role at UNC Health
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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.

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.

• Appeals & Managed Care Escalations:
  Project manage all 3rd party appeals including researching and determining if carrier denial of claim is valid and, if not, abstracting information from medical records to support appeal of denial. Work 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.
• 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.
• Patient & Provider Follow‑up:
  Review, resolve and, if necessary, elevate to management patient‑level issues stemming from contested charges, Risk Management or Patient Relations.
• 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.
• 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.
• Payor Audits & Pro‑Active Medical Records Requests:
  Oversee and document all submissions pertaining to payor‑generated pre‑payment audits and/or medical records requests.
• AR Reduction & Quality Review Projects:
  Identify and project manage higher‑level AR Reduction projects. Assist management with quality audits including reviewing and approving adjustment requests at their approved level.
• Analysis:
  Use available reporting tools to analyze, trend/quantify and, if necessary, elevate to appropriate stakeholders to drive improvements in preventing denials or resolving aging accounts.
• Research & Transplant:
  Perform charge reviews, follow‑up and payment allocations for HB & PB Transplant Services. Review and correct billing issues with Research Accounts to ensure proper billing.
• 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 that impact successful account resolution.

• High school diploma or GED.

• No licensure or certification required.

• Three (3) years of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow‑Up, Call‑Center, or Collections).

• Excellent written and verbal communication skills.
• Intermediate…