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Description

Summary:

The Government or Non-government Lead coordinates the daily activities of a team of specialists for either government or non-government insurance claims. Is responsible for reviewing, submitting and resolving assigned insurance accounts to an appropriate financial resolution in accordance with regulatory, legal, and compliance guidelines.

Processes all assigned government and nongovernment accounts and denials for complex financial appeals, with a goal of bringing the accounts to an appropriate financial resolution in accordance with regulatory, legal, and compliance guidelines. Follows rules for overturning appeals and rejections for these accounts. Completes additional research and coordinates with other departments, provider offices and insurers. Assists Manager of Patient Financial Services in maintaining accounts receivables at appropriate levels.

Submits insurance claims to the appropriate payers on a daily basis in adherence to applicable regulatory, legal, and compliance guidelines. Assists the Manager & Revenue Cycle Director in all aspects of claims processing.

Responsibilities:

1. Oversees either the government or non-government team in medical claim processing.

2. Coordinates daily activities of their team.

3. Ensures Work Queues are at appropriate levels and being worked appropriately.

4. Works accounts escalated by team and resolves or escalates errors.

5. Satisfies goals pertaining to audits, productivity and quality standards. Escalates risks and successes to the Manager of Patient Financial Services.

6. Assists with the onboarding of new teammates and addresses team training needs.

7. Responsible for the accurate and timely submission of claims, response to denials, and re-bills of insurance claims, and all aspects of insurance follow-up and collections.

8. Interfaces with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write offs, refunds or other methods.

9. Verifies claims adjudication utilizing appropriate resources and applications. Reconciles accounts, researches and resolves a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, sequencing of charges, and non-payment of claims.

10. Supports follow up and denial work. Researches and resolves a variety of issues relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims. Contacts patients, providers and insurance companies to obtain information necessary for invoice or account resolution through write-offs, reversals, adjustments, refunds or other methods.

11. Participates and attends meetings, training seminars and in-services to develop job knowledge.

12. Participates in Revenue Cycle and organizational initiatives as directed.

13. Assists with the onboarding of new staff and team training initiatives.

14. Provides input into 90 day and annual performance appraisals for the area.

15. Satisfies goals pertaining to productivity and quality expectations.

16. Serves as a resource and role model to teammates.

17. Promotes team morale.

WAYNE

Other information:

Education

High School diploma or GED required.

Licensure/Certification

CRCR (Certified Revenue Cycle Representative) within one year of hire.

Experience

Minimum two (2) years of experience in Hospital or Physician Insurance related activities (Authorization, Billing, Follow-Up, Call-Center, or Collections).

Knowledge, Skills and Abilities

• Good organizational, follow up and attention to detail skills.

• Excellent customer service and interpersonal skills.

• Ability to lead, guide and motivate others.

• Ability to read, write and communicate effectively in English.

• Proficient with MS Office, EPIC or EMR software, with the ability to learn new software rapidly.

Valid NC Driver’s License: No

If driving a Wayne UNC Vehicle, must be 21 years old and MVR must be approved by Risk Management.

BO-208

01.8522.BO-208.NON-CLIN

Job Details

Legal Employer: Wayne Health

Entity: Wayne UNC Health Care

Organization Unit: Patient Accounts

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: WAYNE MED

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.