Revenue Cycle Representative

UNC Health•Rocky Mount, NC

1d•Hybrid

About The Position

The Revenue Cycle Representative performs complex revenue-cycle duties, including follow-up on outstanding insurance claims with no payer response, claims with edits, and claims denied for claim-form issues. The role maintains accounts receivable at acceptable aging levels through prompt follow-up on unpaid and denied claims and timely resolution of credit balances. It also addresses billing-related customer concerns and performs all duties in a manner that supports teamwork and UNC Health Care’s mission and philosophy. The position works under the direction of the Patient Financial Services Manager. The Representative supports accurate, compliant claim submission and billing by investigating account issues, coordinating with patients, physicians, insurance carriers, and internal and external departments, and resolving discrepancies. The role also maintains work queues, reviews correspondence, documents collection activity, and meets or exceeds productivity and quality standards.

Requirements

High school diploma or equivalent.
Maintain a basic understanding and knowledge of health insurance plans, policies, and procedures.

Nice To Haves

1–3 years of prior experience in hospital operations or finance.
Analytical skills relevant to cash posting, reconciliation, business or finance, or medical terminology.
Patient Financial Services experience in a professional or hospital setting.

Responsibilities

Submit insurance claims accurately and on time, 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 the scope of authority or escalate as needed to satisfy 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 when required by insurance carriers, and submit requested medical information.
Analyze and correct patient invoices or accounts as needed for clean claim submissions or rebills.
Maintain work queues and 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 investigate and resolve issues involving payments, charges, denials, secondary billing, charge sequencing, and nonpayment.
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 based on carrier and departmental information.
Read and interpret explanations of benefits (EOBs).
Maintain a basic understanding of health insurance plans, policies, and procedures.
Accurately and thoroughly document collection activity.
Attend meetings, training seminars, and in-services to develop job knowledge.
Meet or exceed productivity and quality standards.