Rev Cycle Representative II

Job Details

Revenue Cycle Representative

Job Description

This position is hybrid. We are seeking experience with payor payment denials. Must have three (3) to five (5) years of experience.

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

• Payer-Specific Knowledge: Knowledge of various insurance plans (Medicare, Medicaid, commercial payers, managed care, etc.), their specific policies, coverage details, and reimbursement rules. This includes understanding the nuances of how different payers handle medical necessity, referrals, and authorizations, non covered service.
• Extensive knowledge of denial management. (Hospital services)
• Software Proficiency – Microsoft products: Word, Excel, PowerPoint, Outlook.
• Insurance Policies & Reimbursement Methodologies
• Denial Types and Causes: Ability to identify and classify different types of denials (e.g., medical necessity, authorization, coding errors, lack of information, coordination of benefits) and their root causes.
• Familiarity with Epic
• Proficiency in using insurance payer portals
• Analytical Thinking: Ability to review complex claim data, identify trends in denials, and analyze root causes to prevent future occurrences. This includes dissecting vague denial codes to pinpoint the actual issue.
• Root Cause Identification: Skill in investigating denials to determine the underlying reason for rejection, whether it’s a coding error, missing documentation, or a pre-authorization issue.
• Strong Written Communication: Exceptional ability to write clear, concise, and persuasive appeal letters, reconsideration requests, and detailed documentation supporting the medical necessity of services.
• Familiarity with Independence Blue Cross, Blue Cross Blue Shield, Horizon BCBS NJ, Highmark, United Healthcare, Cigna.
• 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

$20.16 to $28.73

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

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Kennedy University Hospitals, Inc

Primary Location Address

500 Marlboro Avenue, Cherry Hill, New Jersey, United States of America

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

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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