Revenue Cycle Representative Senior

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

The Revenue Cycle Representative Senior is responsible for performing a variety of complex duties in support of the revenue cycle, from pre-service activities such as prior authorizations and insurance verification to post-service billing, follow-up, and collections. The role requires substantial knowledge of carrier policies, procedures, and practices, participates in special projects, and assists new or existing staff with training and techniques to support productivity and quality.

The current focus of this position is pre-service insurance coverage verification and Real-Time Eligibility (RTE), serving as an advanced resource and subject matter expert for complex eligibility investigations, optimization efforts, trend identification, and quality review. As departmental, organizational, or enterprise needs evolve, the role may support alternative revenue cycle functions or workflows. All duties are performed in a manner that promotes teamwork and reflects UNC Health’s mission and philosophy.

Responsibilities:

• Perform advanced insurance coverage verification and benefit investigation activities.

• Investigate and troubleshoot complex eligibility and Real-Time Eligibility (RTE) issues.

• Identify recurring payer, benefit, workflow, or system-related trends affecting verification accuracy.

• Serve as a subject matter expert for coverage verification workflows, payer requirements, benefit interpretation, and eligibility processes.

• Conduct quality audits to evaluate documentation accuracy, verification quality, adherence to department procedures, and consistency of work performed.

• Provide constructive feedback and coaching based on quality review findings.

• Assist with onboarding, training, and mentoring newly hired Revenue Cycle Representatives.

• Develop and maintain training materials, tip sheets, standard operating procedures, and workflow documentation.

• Monitor quality trends and identify opportunities for process improvement and staff development.

• Escalate high-impact payer, system, and eligibility issues to leadership.

• Participate in workflow redesign, process improvement, reporting, and automation initiatives.

• Support departmental projects, testing efforts, and implementation of new verification workflows.

• Serve as an operational resource and escalation point for complex payer and coverage questions.

Other Information

Other information:

Education Requirements:

• High school diploma or GED required; higher-level degree may satisfy this requirement.

Licensure/Certification Requirements:

• No licensure or certification required.

Professional Experience Requirements:

• Three (3) years of experience in Hospital or Physician Insurance related activities (Verification, Authorization, Billing, Follow-Up, Call-Center, or Collections).

• Experience with Epic eligibility workflows, workqueues, and coverage verification processes preferred.

• Experience training, onboarding, mentoring, or coaching staff preferred

Knowledge/Skills/and Abilities Requirements:

• Advanced knowledge of insurance verification and benefit interpretation.

• Knowledge of commercial, Medicare, Medicaid, and managed care plans.

• Strong analytical, technical, and problem-solving skills.

• Ability to identify root causes and recommend workflow improvements.

• Advanced knowledge of MS Office application.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: PFE Coverage Coordination

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $19.98 - $28.54 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

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.

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.