Revenue Cycle Representative

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.

• Responsible for performing a variety of complex duties, including working outstanding insurance claims follow up for no response from payors and claim denials.
• Works physician claims (“professional billing”).
• 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.

• Accurate and timely submission of claims follow up, reconsideration and appeals, response to denials, and re‑bills of insurance claims.
• Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers.
• Submit requested medical information to insurance carrier.
• Analyze and correct invoices or accounts and maintain work queues.
• Access, review and respond to third party correspondence.
• Research and resolve issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non‑payment of claims.
• Contact insurance companies to obtain information necessary for invoice or account resolution through write‑offs, reversals, adjustments or other methods.
• Verify claims adjudication utilizing appropriate resources and applications.
• Reconcile accounts and research issues relating to posting of payments, insurance denials, 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 PB Claims operations.
• Evaluate carrier and departmental information and determine 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.
• Meet/Exceed productivity and quality standards.

High School Degree

None

Two (2) years of experience in hospital or physician insurance related activities (Authorization, Billing, Follow‑Up, Call‑Center, or Collections).

• Knowledge of health insurance billing, denials, and collections processes.

• Ability to analyze and correct invoices or accounts.

• Strong communication skills and attention to detail.

• Familiarity with EOBs and carrier terminology.

• Proficiency in using billing software and applications.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
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.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.