Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Reviews, verifies, edits and submits/transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies. Assures claim and data submission is timely, accurate and compliant with third party payor requirements and federal and state regulations. Reviews third party payor payments, explanations of benefits/payments and other correspondence.

Responsibilities:

• Reviews, verifies, edits and submits/transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies. Assures claim and data submission is timely, accurate and compliant with third party payor requirements and federal and state regulations. Reviews third party payor payments, explanations of benefits/payments and other correspondence received to assure accurate processing has occurred. Initiate corrective action as indicated.

• Communicates with managers to troubleshoot problem claims, gather additional information, or make corrections for billing.

• Tracks patient and insurance credit balances, to ensure that all credit payments are zeroed out by end of quarter.

• Manages workflow to maximize the volume of claims corrected and filed.

• Communicates with the Billing Manager to provide potential solutions on a system level to prevent failed claims.

• Reviews daily encounter forms to ensure that charges seem reasonable and have been put on the correct visit.

• Communicates with staff regarding authorization information; enter all authorization information into patient file and maintain patient billing/authorization file updates.

• Communicates with insurance companies to obtain patient eligibility, benefits, co-pays, policy restrictions; obtains all billing requirements (type of bill, CPT codes); communicate with Insurance case managers and staff regarding authorization information; enter all authorization information into patient file and maintain patient billing/authorization file updates.

• Responsible for advising management when rate changes are warranted.

• Respond to any portal messages sent by administration staff, clinical staff, and patients in a timely manner.

Other Information

Education Requirements:

• High school diploma or general education degree (GED) required. Bachelor's degree preferred.

Licensure/Certification Requirements:

• None required.

Professional Experience Requirements:

• Two years of office management in a health care setting. Computer skills required, with Microsoft Word and Excel experience preferred.

Knowledge, Skills, and Abilities Requirements:

• Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, federal, state and third party claims processing requirements and regulations and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

• Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

• Computer Skills: Ability to use hospital and medical claims processing software. Working knowledge of Word, Excel, Schedule Plus, and Microsoft Exchange. Proficient keyboarding skills.

• Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Job Details

Legal Employer: STATE

Entity: UNC Faculty Physicians

Organization Unit: FP UNC Fertility Clinic

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $18.20 - $25.86 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: US:NC:Raleigh

Exempt From Overtime: Exempt: No

This is a State position employed by UNC Health Care System.

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.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.

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.