Revenue Cycle Representative Senior
About The Position
The Revenue Cycle Representative Senior performs complex duties supporting the revenue cycle, including pre-service activities such as prior authorizations and insurance verification, as well as post-service billing, follow-up, and collections. The position requires substantial knowledge of carrier policies, procedures, and practices; participation in special projects; and support for staff training, productivity, and quality. The current focus is pre-service insurance coverage verification and Real-Time Eligibility (RTE). The role serves as an advanced resource and subject matter expert for complex eligibility investigations, optimization efforts, trend identification, and quality review. As departmental, organizational, or enterprise needs evolve, the position may support other revenue cycle functions or workflows. All duties are performed in a manner that promotes teamwork and reflects UNC Health’s mission and philosophy.
Requirements
- High school diploma or GED; a higher-level degree may satisfy this requirement.
- Three years of experience in hospital or physician insurance-related activities, such as verification, authorization, billing, follow-up, call-center work, or collections.
- Advanced knowledge of insurance verification and benefit interpretation.
- Knowledge of commercial, Medicare, Medicaid, and managed care plans.
- Strong analytical, technical, and problem-solving skills.
- Ability to identify root causes and recommend workflow improvements.
- Advanced knowledge of Microsoft Office applications.
Nice To Haves
- Experience with Epic eligibility workflows, workqueues, and coverage verification processes.
- Experience training, onboarding, mentoring, or coaching staff.
Responsibilities
- Perform advanced insurance coverage verification and benefit investigation activities.
- Investigate and troubleshoot complex eligibility and Real-Time Eligibility (RTE) issues.
- Identify recurring payer, benefit, workflow, or system-related trends that affect verification accuracy.
- Serve as a subject matter expert on coverage verification workflows, payer requirements, benefit interpretation, and eligibility processes.
- Conduct quality audits to evaluate documentation accuracy, verification quality, adherence to department procedures, and consistency of work.
- Provide constructive feedback and coaching based on quality review findings.
- Assist with onboarding, training, and mentoring newly hired Revenue Cycle Representatives.
- Develop and maintain training materials, tip sheets, standard operating procedures, and workflow documentation.
- Monitor quality trends and identify opportunities for process improvement and staff development.
- Escalate high-impact payer, system, and eligibility issues to leadership.
- Participate in workflow redesign, process improvement, reporting, and automation initiatives.
- Support departmental projects, testing efforts, and implementation of new verification workflows.
- Serve as an operational resource and escalation point for complex payer and coverage questions.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
