Rev Cycle Representative II

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

2d • Onsite

About The Position

Responsible for reviewing, analyzing, and initiating appropriate action to resolve complex claim denials by communicating with payers, hospital departments, and patients. This role specializes in accounts receivable for implant carve-outs, recovering payments for surgical implants and high-cost drugs billed separately from standard hospital procedure packages. The work includes applying specialized medical revenue cycle knowledge, analytical skills, and insurance payer experience to support accurate billing and collections.

Requirements

• High school diploma or 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.
• Ability to communicate professionally with patients, insurance carriers, physician offices, and hospital departments.
• Ability to work independently with minimal supervision.
• Ability to meet department productivity and quality requirements.

Nice To Haves

• Associate or bachelor's degree preferred.
• Experience working with Epic preferred.
• Experience in hospital billing, medical accounts receivable, or healthcare collections.
• Specialized expertise in surgical implants, high-cost drugs, and hospital contract carve-outs.
• Proven ability to analyze, appeal, and overturn insurance claim denials and underpayments.
• Strong verbal and written skills for disputing underpayments with insurance payers.
• High attention to detail in auditing Explanation of Benefits against managed care contracts.

Responsibilities

• Review, analyze, and take appropriate action to resolve complex claim denials.
• Develop effective appeal strategies, including authorization research, rebilling, and balance write-off or transfer to the next responsible party.
• Communicate with third-party payers, hospital departments, and patients to obtain information needed to resolve denials.
• Use reference materials and payer websites, or contact payers as needed, to troubleshoot payer issues and improve understanding of denial resolution techniques.
• Maintain understanding of third-party regulations for appeals and appeal follow-up.
• Communicate courteously and professionally with patients, insurance carriers, physician offices, coworkers, visitors, and other hospital departments.
• Maintain productivity and quality requirements established by department policy.
• Perform other duties as assigned by the supervisor.
• Match hospital surgery logs, itemized bills, and manufacturer implant invoices to support accurate billing.
• Audit Explanation of Benefits against managed care contracts to identify missing revenue.
• Analyze and appeal insurance denials and underpayments, and professionally dispute underpayments with payers.

Benefits

• Medical insurance, including prescription coverage
• Supplemental insurance
• Dental insurance
• Vision insurance
• Life and AD&D insurance
• Short- and long-term disability insurance
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits, including access to group insurance rates and discounts
• Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
• Access to medical insurance, including prescription coverage, for all colleagues, including per diem colleagues, adjunct faculty, and Jeff Temps

What This Job Offers

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