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; respond to denials and re-bill claims as necessary.
- Perform insurance follow-up and collections, coordinating with internal teams and insurance carriers to resolve discrepancies through charge corrections, payment adjustments, write-offs, or refunds.
- Edit claims within scope of authority to meet billing compliance guidelines; escalate issues as needed.
- Contact insurance carriers to obtain authorizations and referral approvals for services and procedures.
- Research medical records to gather information supporting medical justification for procedures; submit required documentation to insurance carriers.
- Analyze and correct patient invoices or accounts to ensure clean claim submissions or re-bills.
- Maintain work queues and manage third-party correspondence via document management systems.
- Research and resolve issues related to payment posting, insurance denials, secondary billing, credit balances, charge sequencing, and non-payment of claims.
- Communicate with patients, physicians, and insurance companies to obtain information necessary for invoice or account resolution.
- Verify claims adjudication and post insurance and patient payments and denials accurately and promptly.
- Reconcile accounts and identify trends or issues; provide suggestions for resolution to management.
- Maintain data tables supporting patient accounting operations and evaluate carrier and departmental information.
- Read and interpret Explanation of Benefits (EOBs).
- Maintain knowledge of health insurance plans, policies, and procedures.
- Document collection activities thoroughly and participate in meetings and training to develop job knowledge.
- Meet or exceed productivity and quality standards.
Requirements
- High school diploma or equivalent.
- Minimum of two (2) years of experience in hospital or physician insurance-related activities such as authorization, billing, follow-up, call center, or collections.
Compensation & Benefits
- Salary range: $18.12 - $25.51 per hour (hiring range).
- Pay offers are determined by experience and internal equity.
- Full-time position with a standard 40-hour workweek.
- Day shift schedule.
- Remote work assignment.
Location
- Chapel Hill, North Carolina, United States.
Additional Information
- This position is employed by a private, fully-owned subsidiary providing shared services across a healthcare system.
- Equal opportunity employer committed to considering qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, veteran status, or political affiliation.
- Reasonable accommodations are available for applicants and employees with disabilities or religious practices upon request.