Rev Cycle Representative II

Job Details

Job Description

PRIMARY FUNCTION: Responsible for reviewing, analyzing and initiating appropriate action for complex case claim denial resolution by communicating with payers, hospital departments and patients.

ESSENTIAL FUNCTIONS:

* Completes appropriate strategy for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer to next responsible party.

* Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution.

* Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites or contact as needed.

* Maintains understanding of third party regulations for appeals and appeal follow-ups.

* Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson

EDUCATIONAL/TRAINING REQUIREMENTS:

High School Diploma / GED required

Associates or Bachelors degree preferred

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CERTIFICATES, LICENSES, AND REGISTRATION:

Revenue Cycle certification preferred

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EXPERIENCE REQUIREMENTS:

• Minimum 3 years of experience working in hospital revenue cycle
• Working knowledge of insurance plans and contract language

• Computer skills, including proficiency in Windows 10 and Microsoft Office.

• Knowledge of State and Federal healthcare billing and coding guidelines
• Experience working with Epic preferred

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ADDITIONAL INFORMATION:

• Exceptional communication and interpersonal skills (both written and verbal)

• Ability to work collaboratively and effectively with others
• Understanding of medical terminology
• Knowledge of CPT coding and ICD-10 preferred
• Licensed practical nursing degree preferred
• Strong organizational skills
• Position is eligible for telecommuting (work from home).

Salary Range

The actual hiring rate will be determined based on candidate experience, skills and qualifications. This position is not eligible for an annual incentive.

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

At Jefferson, we offer a comprehensive total rewards package designed to support the health and well-being of our colleagues and their families. It includes a wide range of benefits including competitive pay, health and retirement benefits, life and disability insurance, paid time off, educational benefits, financial and mental health resources and much more. Our diverse benefits offerings ensure you have the coverage and access to services you need to thrive both personally and professionally.