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Job Details

Revenue Cycle Denials Receivable Representative

Department: Revenue Cycle - CFH_10_19
Usual Schedule: Mon - Fri 8-5
Regions: Carle Foundation
On Call Requirements: no
Job Category: Clerical/Admin
Work Location: Working from Home
Employment Type: Full - Time
Nursing Specialty:
Job Post ID: 46100
Secondary Job Category:
Experience Requirements: 1 - 3 Years
Weekend Requirements: no
Education Requirements: HS Diploma/GED
Shift: Day
Location: Remote
Holiday Requirements: no
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Check out this job opening for Carle Providers: Revenue Cycle Denials Receivable Representative Check out this job opening for Carle Providers: Revenue Cycle Denials Receivable Representative


Job Description

JOB 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.

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:
  • Must be able to perform essential job functions of Revenue Cycle Accounts Receivable Representative 1.
  • 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).
  • Handles escalated account activities such as but not limited to healthcare liens, settlement requests, workers’ compensation reimbursement computation forms and attorney requests.
  • Handles escalated appeals.
  • Assists with training and education to staff for accuracy.
  • Identifies payer and system issues to initiate project requests for process improvements.
  • 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.



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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are committed to creating a diverse and welcoming workplace that includes partners with diverse backgrounds and experiences. We believe that enables us to better meet our mission and values while serving customers throughout our communities. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances. 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: human.resources@carle.com. Positions are not available for remote work in the state of Colorado.

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.

 

Illinois Required Notices

Federal Required Notices