Rev Cycle Representative II

Jefferson Health Plans • Dixon Hall (formerly Pennwood), PA

5d • Onsite

About The Position

Responsible for reviewing, analyzing and initiating appropriate action for complex case claim denial resolution by communicating with payers, hospital departments and patients. This role involves completing appropriate strategy for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer for next responsible party. The representative will correspond with third party payers, hospital departments, and patients to obtain information required for denial resolution, and use reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Maintaining an understanding of third party regulations for appeals and appeal follow-up is also a key aspect of this position.

Requirements

• High School Diploma/GED required
• Minimum 3 years of experience working in hospital revenue cycle
• Working knowledge of insurance plans and contract language
• Computer skills, including proficiency in Windows 10 and Microsoft Office
• Knowledge of State and Federal healthcare billing and coding guidelines.
• Demonstrated ability to work independently with minimal supervision.
• Communicate with patients, insurance carriers, physician’s offices, and other hospital departments in a courteous and professional manner.

Nice To Haves

• Associates or Bachelors degree preferred
• Experience working with Epic preferred.

Responsibilities

• Completes appropriate strategy for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer for next responsible party.
• Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution.
• Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques.
• Maintains understanding of third party regulations for appeals and appeal follow-up.
• Maintains productivity and quality requirements as defined by department policy.
• Other duties as assigned by supervisor.

Benefits

• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• voluntary benefits
• tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.

What This Job Offers

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