Government/Non-Government Specialist
Company: UNC Health Care
Location: Goldsboro
Posted on: November 16, 2023
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Job Description:
**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:
The Government-Non-government Specialist is responsible for
reviewing, submitting and resolving assigned insurance accounts to
an appropriate financial resolution in accordance with regulatory,
legal, and compliance guidelines
Processes all assigned government and nongovernment accounts and
denials for complex financial appeals, with a goal of bringing the
accounts to an appropriate financial resolution in accordance with
regulatory, legal, and compliance guidelines. Follows rules for
overturning appeals and rejections for these accounts. Completes
additional research and coordinates with other departments,
physician offices and insurers. Also performs follow-up
responsibilities of a financial counselor. Assists Revenue Cycle
Director in maintaining accounts receivables at appropriate
levels.
Submits insurance claims to the appropriate payers on a daily basis
in adherence to applicable regulatory, legal, and compliance
guidelines. Assists the Manager and Director in all aspects of
claims processing.
Responsibilities:
1. Works insurance related billing errors in Epic and SSI.
2. Works accounts from follow up work queues in Epic.
3. Works denials in Epic towards resolution.
4. Coordinates with other teams/departments/payors to resolve
account errors.
5. Posts adjustments and write offs as needed.
6. Leverages Lead as a resource to address account issues and
questions.
7. Ensures work queues are worked appropriately and timely.
8. Satisfies goals pertaining to audits, productivity and quality
standards.
9. Responsible for the accurate and timely submission of claims,
response to denials, and re-bills of insurance claims, and all
aspects of insurance follow-up and collections.
10. Interfaces with internal and external departments to resolve
discrepancies through charge corrections, payment corrections,
write offs, refunds or other methods.
11. Researches and resolves a variety of issues relating to posting
of payments and charges, insurance denials, secondary billing
issues, credit balances, sequencing of charges, and non-payment of
claims. Contacts patients, providers and insurance companies to
obtain information necessary for invoice or account resolution
through write-offs, reversals, adjustments, refunds or other
methods.
12. Verifies claims adjudication utilizing appropriate resources
and applications. Reconciles accounts, researches and resolves a
variety of issues relating to posting of payments and charges,
insurance denials, secondary billing issues, sequencing of charges,
and non-payment of claims.
13. Responds to any assigned correspondence in a timely,
professional, and complete manner.
14. Participates and attends meetings, training seminars and
in-services to develop job knowledge.
15. Meets or exceeds goals pertaining to productivity and quality
expectations.
16. Assists in training teammates within the
Government/Non-Government teams.
17. Serves a resource and role model for other teammates in the
area.
WAYNE
Other information:
Education
High School diploma or GED required.
Licensure/Certification
CRCR (Certified Revenue Cycle Representative) certification from
HFMA within one year of hire.
Experience
Two (2) years prior experience in Hospital or Physician Insurance
related activities (Authorization, Billing, Follow-Up, Call-Center,
or Collections).
Knowledge, Skills and Abilities
--- Good organizational, follow up and attention to detail
skills.
--- Excellent customer service and interpersonal skills.
--- Ability to read, write and communicate effectively in
English.
--- Proficient with MS Office, Epic/ EMR software, with the ability
to learn new software rapidly.
Valid NC Driver's License: No
If driving a Wayne UNC Vehicle, must be 21 years old and MVR must
be approved by Risk Management.
BO-209
01.8522.BO-209.NON-CLIN
**Job Details**
Legal Employer: Wayne Health
Entity: Wayne UNC Health Care
Organization Unit: Patient Accounts
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: WAYNE MED
Exempt From Overtime: Exempt: No
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.
Keywords: UNC Health Care, Wilson , Government/Non-Government Specialist, Government & Protective Services , Goldsboro, North Carolina
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