Revenue Cycle Denials Receivable Representative

Position Summary

Proficient in Revenue Cycle Denials Receivable Representative 1. Responsible for handling escalated account and payer issues. Handles complex edits, appeals and account activities such as advanced level tasks, bankruptcies, Risk Management. Acts as a billing and reimbursement expert for a defined payer product line.

Qualifications

EDUCATIONAL REQUIREMENTS

Associate's degree preferred.

Certification & Licensure Requirements

None specified

Experience Requirements

One year customer service experience in health care required or a high performer as an Accounts Receivable Representative 1. Credit and collection experience preferred. Proficient computer knowledge related to Microsoft Office applications such as Word, Excel, Outlook and Receivables Management systems.

Skills And Knowledge

Possesses the "other knowledge and skills" of the Revenue Cycle Accounts Receivable Representative 1. Knowledge of basic medical coding and third-party operating procedures and practices with proficiency in EncoderPro.

Essential Functions

• Handles escalated appeals.
• Handles escalated account activities such as but not limited to healthcare liens, settlement requests, workers’ compensation reimbursement computation forms and attorney requests.
• Assists in credit balance review according to organization’s credit balance/refund policy.
• Attends and participates in meetings with payer specific provider representatives to maximize reimbursement and minimize denials through problem solving, collaboration and consensus.
• Identifies payer and system issues to initiate project requests for process improvements.
• Handles complex edits, correspondence and advanced level workqueues such as but not limited to retro review, EOB balancing, credit adjustment review and processing of Illinois Workers’ Compensation Commission (IWCC).
• Must be able to perform essential job functions of Revenue Cycle Accounts Receivable Representative 1.
• Assists with training and education to staff for accuracy.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.