Medical Insurance Claims Jobs in Raleigh, NC (NOW HIRING)

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Job Summary:
Responsible for performing a variety of complex duties, including but not limited to, working outstanding insurance claims follow up for no authorization post claim. Maintains A/R at acceptable aging levels by prompt follow-up of denied claims. Performs all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy. This position will report to the PB Authorization Denials Supervisor
Description of Job Responsibilities:
• Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals, response to denials, and re-bills of insurance claims, and all aspects of insurance follow-up and collections including interfacing with internal and external departments to resolve discrepancies through charge corrections, payment corrections, write-offs, other methods.
• Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers and submit reconsiderations or appeals necessary to overturn authorization denials. Submits requested medical information to insurance carrier as requested.
• Responsible for the analysis and necessary corrections of invoices or accounts and maintaining work queues. Access, review and respond to third party correspondence. Navigate websites as it relates to authorizations.
• Research and resolve a variety of authorization issues which can include understanding of insurance guidelines surrounding authorizations and referrals, i.e., navigating PPA lists. Contact insurance companies to verify authorizations on file and authorization policies and submit retro authorization.
• Respond to any assigned correspondence in a timely, professional, and complete manner. Identify issues and/or trends and provide suggestions for resolution to management, including payer, system or escalated account issues. May maintain data tables for systems that support PB Claims operations. Evaluate carrier and departmental information and determines data to be included in system tables
• Read and interpret EOB's (Explanation of Benefits). Maintain basic understanding and knowledge of health insurance plans, policies and procedures. Accurately and thoroughly document the pertinent collection activity performed. Participate and attend meetings, training seminars and in-services to develop job knowledge. Meets/Exceeds Productivity and Quality standards.
Other Information
Other information:
Education Requirements:
• High School Degree
Licensure/Certification Requirements:
Professional Experience Requirements:
• Two (2) years of experience in hospital or physician insurance related activities ((Authorization, Billing, Follow-Up, Call-Center, or Collections)
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Physician Ins Billing and Foll
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $18.12 - $25.51 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: No
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
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.