Rev Cycle Representative I

Jefferson Health Plans • Philadelphia, PA

17h • Onsite

About The Position

PRIMARY FUNCTION: This position will follow-up with insurance payors on rejected or underpaid claims, initiate claim reviews and work open claims in a timely manner to maximize reimbursement. ESSENTIAL FUNCTIONS: Follow-up with insurance payors on rejected or underpaid claims. Initiate claim reviews where appropriate. Work open claims in a timely manner to maximize reimbursement. Resubmit claims to insurance payors with appropriate modifications. Ability to understand insurance denial codes and take corresponding action to resolve the denial. Knowledge of insurance registration and ability to use payor websites to verify patient eligibility. Remain current and knowledgeable regarding insurance payors rules and regulations such as Medicare, Medicaid, BC/BS and commercial carriers. Ability to meet weekly productivity standards established for all staff. Identify and report to Manager any rejection trends or other issues that affect reimbursement. Experience with Epic follow-up system or other automated follow-up system that requires documentation of actions. Good communications skills as position requires frequent contact with physician practice staff and insurance payor representatives. Flexibility to work in a team environment and to accept special projects. Interacts with co-workers, visitors, and other staff consistent with the core values of Jefferson. Other duties assigned.

Requirements

• High School or GED equivalent required
• Two to three years accounts receivable/billing experience in a physician practice, hospital or ancillary medical billing office.
• Will also consider experience in insurance claims processing.

Nice To Haves

• Preferred knowledge of third party rules and regulations.
• Knowledge of ICD-10 and CPT coding preferred.
• Experience in Epic billing system highly desirable.

Responsibilities

• Follow-up with insurance payors on rejected or underpaid claims.
• Initiate claim reviews where appropriate.
• Work open claims in a timely manner to maximize reimbursement.
• Resubmit claims to insurance payors with appropriate modifications.
• Ability to understand insurance denial codes and take corresponding action to resolve the denial.
• Knowledge of insurance registration and ability to use payor websites to verify patient eligibility.
• Remain current and knowledgeable regarding insurance payors rules and regulations such as Medicare, Medicaid, BC/BS and commercial carriers.
• Ability to meet weekly productivity standards established for all staff.
• Identify and report to Manager any rejection trends or other issues that affect reimbursement.
• Experience with Epic follow-up system or other automated follow-up system that requires documentation of actions.
• Good communications skills as position requires frequent contact with physician practice staff and insurance payor representatives.
• Flexibility to work in a team environment and to accept special projects.
• Interacts with co-workers, visitors, and other staff consistent with the core values of Jefferson.
• Other duties assigned.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED