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UNC Health · 6 hours ago

Revenue Cycle Representative Senior - Customer Service Call Center

Chapel Hill, NC

Full-time

Hybrid

Mid, Senior Level

$19.59/hr - $27.84/hr

3+ years exp

UNC Health is an inclusive organization with over 40,000 teammates dedicated to improving health and well-being in unique communities. The Revenue Cycle Representative Senior is responsible for managing complex reimbursement duties, training staff, and ensuring effective communication between patients and providers throughout the revenue cycle.

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Responsibilities

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

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: Will review, resolve and if necessary escalate 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: Identifies and project manages higher-level AR Reduction projects. Assists management with quality audits including reviewing and approving adjustment requests at their approved level

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

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

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