Overview
This role involves managing complex insurance claims processes, including follow-up on unpaid or denied claims, posting payments and adjustments, and maintaining accounts receivable at acceptable aging levels. The position requires collaboration with internal and external departments to resolve discrepancies and ensure accurate billing compliance.
Responsibilities
- Submit insurance claims accurately and timely, including re-bills and responses to denials.
- Perform insurance follow-up and collections, interfacing with internal and external parties to resolve discrepancies through charge corrections, payment corrections, write-offs, refunds, or other methods.
- Edit claims within scope of authority to meet billing compliance guidelines; escalate as needed.
- Contact insurance carriers to obtain authorizations and referral approvals for services and procedures.
- Research medical records to gather information and substantiate medical justification for procedures as required.
- Submit requested medical information to insurance carriers.
- Analyze and correct patient invoices or accounts related to clean claim submissions or re-bills.
- Maintain work queues and respond to third-party correspondence via Document Management system.
- Research and resolve issues related to payment posting, insurance denials, secondary billing, credit balances, sequencing of charges, and non-payment of claims.
- Contact patients, physicians, and insurance companies to obtain information necessary for invoice or account resolution.
- Verify claims adjudication using appropriate resources and applications.
- Post insurance and patient payments and denials to patient accounts accurately and timely.
- Reconcile accounts and respond to assigned correspondence professionally and promptly.
- Identify issues or trends and provide suggestions for resolution to management.
- Maintain data tables supporting Patient Accounting operations as needed.
- Read and interpret Explanation of Benefits (EOBs).
- Maintain knowledge of health insurance plans, policies, and procedures.
- Document collection activities thoroughly.
- Participate in meetings, training seminars, and in-services to develop job knowledge.
- Meet or exceed productivity and quality standards.
Requirements
- High school diploma or GED.
- Two (2) years of experience in hospital or physician insurance-related activities such as authorization, billing, follow-up, call-center, or collections.
- Excellent interpersonal, verbal, and written communication skills.
- Strong listening and organizational skills.
- Advanced knowledge of UB-04, HCFA-1500 forms, and Explanation of Benefits (EOB) interpretation.
- Intermediate knowledge of CPT and ICD-9 codes.
- Advanced knowledge of insurance billing, collections, and insurance terminology.
- Ability to work in a fast-paced environment and manage multiple tasks.
- Familiarity with healthcare terminology.
- Customer service skills.
- Proficiency with MS Word, Excel, and Outlook.
- Knowledge of third-party reimbursements from insurance companies and government payers is a plus.
Compensation & Benefits
- Salary range: $18.84 - $26.77 per hour (hiring range).
- Pay offers are determined by experience and internal equity.
- Full-time position, 40 hours per week.
- Day shift schedule.
- Remote work assignment.
Location
- United States, North Carolina, Chapel Hill.
Additional Information
- This position is employed by a private, fully-owned subsidiary providing shared services across a healthcare system.
- Equal opportunity employer; qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, protected veteran status, or political affiliation.
- Reasonable accommodations are available for applicants and employees with disabilities or religious practices.