Revenue Cycle Representative

UNC Health•Chapel Hill, NC

13h•Remote

About The Position

The Revenue Cycle Representative performs complex insurance revenue-cycle duties, including follow-up on outstanding claims without payer responses, claims with edits, and claims denied for claim-form issues. The role maintains accounts receivable at acceptable aging levels through timely follow-up of unpaid and denied claims, reviews credit balances for reallocation or refunds, and may post payments, contractual adjustments, and denials. The representative also processes assigned paper correspondence and performs duties in a way that promotes teamwork and reflects UNC Health’s mission and philosophy. The representative supports accurate and timely claims submission, denial resolution, rebilling, insurance follow-up, and collections. This includes researching and correcting account or invoice issues, obtaining authorizations and referral approvals, gathering and submitting medical information requested by carriers, and maintaining work queues. The role reviews third-party correspondence, verifies claim adjudication, posts payments and denials, reconciles accounts, and documents collection activity. It also identifies issues and trends for management, may maintain system data tables supporting Patient Accounting operations, and participates in meetings and training to develop job knowledge. The role is expected to meet or exceed productivity and quality standards. This is a full-time, remote day-job position with 40 standard hours per week. The stated hiring range is $18.48–$25.89 per hour; pay offers are determined by experience and internal equity.

Requirements

High school degree.
Two years of experience in hospital or physician insurance-related activities, such as authorization, billing, follow-up, call-center work, or collections.

Responsibilities

Accurately and promptly submit insurance claims, respond to denials, and rebill claims.
Perform insurance follow-up and collections, coordinating with internal and external departments to resolve discrepancies through charge or payment corrections, write-offs, refunds, or other methods.
Edit claims, including DNB, Coverage Changes, Claim Edits, and Stop Bills, within authorized scope or escalate them as needed to meet billing compliance guidelines for electronic submission.
Contact insurance carriers to obtain authorizations and referral approvals for services and procedures.
Research medical records to substantiate medical justification for procedures and submit requested medical information to insurance carriers.
Analyze and make necessary corrections to patient invoices or accounts to support clean claim submissions or rebills.
Maintain work queues.
Access, review, and respond to third-party correspondence through the Document Management system.
Research and resolve issues involving payment and charge posting, insurance denials, secondary billing, credit balances, charge sequencing, and unpaid claims.
Contact patients, physicians, and insurance companies to obtain information needed to resolve invoices or accounts through write-offs, reversals, adjustments, refunds, or other methods.
Verify claims adjudication using appropriate resources and applications.
Post insurance and/or patient payments and denials to patient invoices or accounts accurately and promptly.
Reconcile accounts and research and resolve issues involving payment and charge posting, insurance denials, secondary billing, charge sequencing, and non-payment of claims.
Respond to assigned correspondence in a timely, professional, and complete manner.
Identify issues and trends and suggest resolutions to management, including payer, system, or escalated account issues.
May maintain data tables for systems supporting Patient Accounting operations and determine what information to include in system tables based on carrier and departmental information.
Read and interpret Explanation of Benefits (EOBs).
Maintain a basic understanding of health insurance plans, policies, and procedures.
Accurately and thoroughly document collection activity performed.
Attend meetings, training seminars, and in-services to develop job knowledge.
Meet or exceed productivity and quality standards.
Perform duties in a manner that promotes teamwork and reflects UNC Health’s mission and philosophy.