Rev Cycle Representative II

Jefferson Health Plans

2d • 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. Essential Functions Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. 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. Reference payer websites or contact as needed. Maintains understanding of third party regulations for appeals and appeal follow-up. Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. Competencies: Communicate with patients, insurance carriers, physician’s offices, and other hospital departments in a courteous and professional manner. Maintains productivity and quality requirements as defined by department policy. Demonstrated ability to work independently with minimal supervision. Other duties as assigned by supervisor.

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.

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.
• Reference payer websites or contact as needed.
• Maintains understanding of third party regulations for appeals and appeal follow-up.
• Communicate with patients, insurance carriers, physician’s offices, and other hospital departments in a courteous and professional manner.
• Maintains productivity and quality requirements as defined by department policy.
• Demonstrated ability to work independently with minimal supervision.
• Other duties as assigned by supervisor.

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: Mid Level
• Education Level: High school or GED