Job Description

Under the direction of the Revenue Cycle Manager and Supervisor, the Patient Account Representative is responsible for monitoring insurance claims due to no response, pending response, denial and appeal, and proactively resolve balances billed to insurance carriers by way of accurate claim adjudication. This position may also evaluate and resolve under or over payments and requests for refund from insurance carriers.

LOCATION AND YEARS OF EXPERIENCE:
While the position is primarily remote (work from home), on occasion it may be required to work in a normal office environment or
travel to the various hospitals and work locations will be necessary. Work hours may vary from time to time depending upon the
needs of the business. Regular and predictable attendance is required for this position for both remote and in office duties

Responsible for managing follow-up and resolution of professional billing accounts to ensure accurate and timely reimbursement. Conducts detailed research on claim denials, underpayments, and billing discrepancies using multiple systems, and takes appropriate action to optimize collections. Maintains assigned work queues within established productivity and quality standards. Requires solid knowledge of the healthcare revenue cycle, physician/professional billing, and payer reimbursement methodologies.

Minimum Required: High School Diploma or GED. Preferred: Associate's Degree. | LICENSE & CERTIFICATION: N/A. | Minimum Required: 3 – 5 years of relevant experience in Revenue Cycle and/or Epic Revenue Cycle applications.

• Minimum

• 6 months experience in Medical claim follow up.
• Or resolving credit balances
• Or performing electronic or manual cash posting.
• Basic skill with MS Office applications, such as Excel, Print to PDF, Outlook and Fax from mail.

• Preferred:

• 12 months experience in Medical claim follow up.
• Familiar with EPIC Resolute billing system, Claim Clearinghouse and Payer Websites (I.e., Waystar, Availity)

Knowledge Required:

• Understanding of Healthcare Revenue Cycle, from intake to final payment.
• Familiar with CMS-1500 claim form, required components & understanding of basic coding requirements
• Understanding of Basic Payer adjudication concepts & Coordination of Benefits
• Ability to read and understand the Insurance Explanation of Benefits, including interpretation and application of the Remittance Advice or Claim Adjustment reason codes.
• Ability to access and perform functions on various Payer claim portals. (I.e., Availity, Navinet, Anthem, Medicaid, Medicare)
• Familiar with the function of a claims Clearinghouse and the actions they perform (I.e., Zirmend/Waystar, ePremis, etc.)
• Prior use of a claim operating system and it's basic functions. (I.e., EPIC, Athena, NextGen, Meditech)
• Understand common Billing / Insurance acronyms
   

Skills Required

• Possess the ability to self-manage in a work from home environment using excellent communication and organizational skills. Ability to manage daily schedule & accurately report time and attendance.
• Ability to prioritize and coordinate workload with a high degree of proficiency and accuracy.
• Must have excellent analytical and problem-solving skills; possessing good judgement skills and capable of making independent decisions in accord with policy and procedure.
• Ability to reference and apply workflow or other guidance to daily work.
• Able to effectively respond to constantly changing Payer rules with ability to work well under pressure in a flexible, diplomatic and expeditious manner.
• Ability to work professionally and cooperatively with peers and other departments by phone or electronic media. Must incorporate acceptable email and phone etiquette.
• Must be accurate with attention to detail; documenting issue research and actions thoroughly in an abbreviated and comprehensive manner.
• Willingness to learn new process and adjust common work practices when necessary.

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.

UC Health is an EEO employer.