Rev Cycle Representative II at Jefferson Health Plan

Philadelphia, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

24 Jan, 26

Salary

0.0

Posted On

26 Oct, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Payment Research, Cash Processing, Reconciliation, Medical Billing, Accounting, Finance, Microsoft Office, Epic, Data Analysis, Communication, Organizational Skills, Detail Oriented, Interpersonal Skills, Web Tools, Eligibility, Claims Processing

Industry

Insurance Carriers

Description

Job Details Revenue Cycle Representative II Job Description PRIMARY FUNCTION: The Payment Research Representative is responsible for proper handling and reconciliation of payments received throughout the Jefferson Revenue Cycle Enterprise. Working closely with Payment Representatives, Accounting and Finance, the Payment Reconciliation Rep will investigate and resolve issues impacting cash processing and reconciliation. ESSENTIAL FUNCTIONS: Identify and resolve payment issues through research and investigation. Review explanation of benefits to confirm payments were applied appropriately. Contact third party payors or view payor portals to obtain additional information as necessary. Utilize online payor portals, such as Navinet, for claims determination, eligibility, offset requests, appeals. Applies payment and adjustments to patient accounts per third party regulations, providing accurate accounts receivable and balance billing while meeting the department’s established productivity benchmarks. Interprets and validates transaction postings of payments and denials received from third party explanation of benefits either in the form of batched images or via electronic remittance posting work queues. Research over-posted or undistributed credit balances via credit work queues. Confirm that cash records are properly linked to associated payment batches prior to posting. Ensure that batches are posted, reconciled, closed and processed timely and accurately. Communicate possible system and reimbursement issues to the supervisor who will facilitate a review and analysis of the potential impact and confirm best course of action. Adhere to workflows and ensure quality assurance standards are maintained at all times. Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. EDUCATIONAL/TRAINING REQUIREMENTS: High school degree or GED required. Bachelor’s degree in Accounting, Finance or Business preferred EXPERIENCE REQUIREMENTS: Ability to work independently and as part of a team with minimal supervision. Proficient in web tools and technology. Knowledge of Epic preferred. EDI related experience preferred. Medical billing and or banking experience preferred. Accounting and/or Finance experience preferred. Knowledge of Microsoft Office required. Experience with telecommuting preferred. ADDITIONAL INFORMATION: Proficient in Windows 10 and Microsoft Office. Strong MS Excel and Access skills required. Strong organizational and interpersonal skills; excellent verbal and written communication skills. Knowledge of accounting ledgers and balance sheets. Strong understanding of healthcare claims processing, eligibility, enrollment and configuration Skilled in analyzing and comparing data. Extremely detail oriented and well organized. Position is eligible for telecommuting (work from home) Work Shift Workday Day (United States of America) Worker Sub Type Regular Employee Entity Thomas Jefferson University Primary Location Address 615 Chestnut Street, Philadelphia, Pennsylvania, 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. For more benefits information, please click here In keeping with Jefferson's Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education. With a long standing history, Jefferson has been advancing the medical field from the heart of Center City Philadelphia for nearly 200 years. Our Mission, We Improve Lives, expands to every corner of the organization. From our weekly farmer’s market, to our new Jefferson Accelerator Zone for innovation, our employees’ passion for the community is evident by the daily gestures towards our patients, students and each other.

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Responsibilities

The Payment Research Representative is responsible for handling and reconciling payments within the Jefferson Revenue Cycle Enterprise. This role involves investigating and resolving payment issues, ensuring accurate posting and reconciliation of cash records.