Clinic Jobs in Raleigh nc

Job Description

Description

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Summary :

Reviews, verifies, edits and submits / transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies for patient at UNC Fertility. Assures claim and data submission is timely, accurate and compliant with third party payor requirements and federal and state regulations. Reviews third party payor payments, explanations of benefits / payments and other correspondence received to assure accurate processing has occurred. Initiates corrective action as indicated.

Responsibilities :

1. Reviews, verifies, edits and submits / transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies for UNC Fertility patients. Assures claim and data submission is timely, accurate and compliant with third party payor requirements and federal and state regulations. Reviews third party payor payments, explanations of benefits / payments and other correspondence received to assure accurate processing has occurred. Initiates corrective action as indicated.

2. Communicates with billers, managers, and registration staff to troubleshoot problem claims, gather additional information or make corrections for billing for fertility patients.

3. Tracks fertility patient's and insurance credit balances, to ensure that all credit payments are zeroed out by end of quarter.

4. Manages workflow in order to maximize the volume of claims corrected and filed.

5. Communicates with the Operations Manager to provide potential solutions on a system level to prevent failed claims.

6. Reviews daily encounter forms to ensure that charges seem reasonable and have been put on the correct visit.

8. Communicates with other fertility team members authorization information; enter all authorization information into patient file and maintain patient billing / authorization file updates.

9. Communicates with insurance companies to obtain patient eligibility, benefits, co-pays, policy restrictions; obtains all billing requirements (type of bill, CPT codes); ; communicate with Insurance case managers and staff regarding authorization information; enter all authorization information into patient file and maintain patient billing / authorization file updates.

10. Responsible for advising management when rate changes are warrented.

11. Serves as primary contact for Payor Path equipment issues; troubleshoots professional staff daily Payor Path issues; Works with vendor Help Desk to resolve issues.

Other Information

Education Requirements :

• High school diploma or general education degree (GED) required. Bachelor's degree preferred.

Licensure / Certification Requirements :

Professional Experience Requirements :

Knowledge / Skills / and Abilities Requirements :

Job Details

Legal Employer : STATE

Entity : UNC Faculty Physicians

Organization Unit : FP UNC Fertility Clinic

Work Type : Full Time

Standard Hours Per Week : 40.00

Salary Range : $20.03 - $28.52 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type : Onsite

Work Schedule : Day Job

Location of Job : US : NC : Raleigh

Exempt From Overtime : Exempt : No

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

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.

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 [email protected] if you need a reasonable accommodation to search and / or to apply for a career opportunity.