Revenue Cycle Representative

Responsible for performing a variety of complex revenue cycle duties, including outstanding insurance claims follow-up, claim denials, and physician claims (professional billing).

Maintains accounts receivable at acceptable aging levels through prompt follow-up of unpaid and denied claims.

Performs work in a manner that promotes teamwork and reflects UNC Health Care’s mission and philosophy.

Job responsibilities

• Submit claims follow-up, reconsiderations, appeals, denials responses, and re-bills in a timely and accurate manner.
• Coordinate insurance follow-up and collections by working with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write-offs, and other methods.
• Research medical records to substantiate medical justification for procedures as required by insurance carriers.
• Submit requested medical information to insurance carriers.
• Analyze and correct invoices or accounts and maintain work queues.
• Access, review, and respond to third-party correspondence.
• Resolve issues related to payment posting, charge posting, secondary billing, credit balances, sequencing of charges, and non-payment of claims.
• Contact insurance companies to obtain information needed for account resolution.
• Verify claims adjudication using appropriate resources and applications.
• Reconcile accounts and document collection activity thoroughly.
• Identify issues and trends and provide suggestions for resolution to management.
• Maintain data tables supporting physician billing claims operations, as needed.
• Read and interpret EOBs (Explanation of Benefits).
• Maintain a basic understanding of health insurance plans, policies, and procedures.
• Participate in meetings, training seminars, and in-services to develop job knowledge.
• Meet or exceed productivity and quality standards.