Proficient in Revenue Cycle Regional 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.
Qualifications
EDUCATIONAL REQUIREMENTS
College Diploma in Nursing
CERTIFICATION & LICENSURE REQUIREMENTS
Registered Professional Nurse (RN) License Illinois upon hire and Basic Life Support (BLS) (AHA) within 30 days.
ADDITIONAL REQUIREMENTS
Responsibilities
- Must be able to perform essential job functions of Revenue Cycle Regional 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.
About Us
Find it here.
Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health.
Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. 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.