Rev Cycle Representative II

Number of Positions In Requisition
1

Job Details
Revenue Cycle Representative II

Job Description
Responsible for reviewing, analyzing and initiating appropriate action for complex case claim denial resolution by communicating with payers, hospital departments and patients.

Implant Carve-Out Accounts Receivable Representative
Specialized medical billing and collections professional. Focus on recovering payments for surgical implants (like pacemakers, orthopedic joints, or hardware) and high-cost drugs that are billed separately ("carved out") from standard hospital procedure packages.
Looking for a combination of specialized medical revenue cycle knowledge, analytical skills, and experience with insurance payers.

- Experience in hospital billing, medical accounts receivable, or healthcare collections.

- Specialized Expertise: Surgical implants and high-cost drugs; hospital contract carve-outs. Matching hospital surgery logs, itemized bills, and manufacturer implant invoices to ensure billing accuracy.

- Denial Management: Proven ability to analyze, appeal, and overturn insurance claim denials and underpayments.

- Negotiation & Communication: Strong verbal and written skills to professionally dispute underpayments with insurance payers.

- Analytical Auditing: High attention to detail to audit Explanation of Benefits (EOBs) against managed care contracts to find missing revenueI.

Essential Functions

- Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

- Completes appropriate strategy for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer for 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-up.

- Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Competencies (Knowledge, Skills, and Abilities Required):
Communicate with patients, insurance carriers, physician’s offices, and other hospital departments in a courteous and professional manner.
Maintains productivity and quality requirements as defined by department policy.
Demonstrated ability to work independently with minimal supervision.
Other duties as assigned by supervisor.

Minimum Education and Experience Requirements:

Education:
High School Diploma/GED required
Associates or Bachelors degree preferred
AND
Experience:
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.

Work Shift
Workday Day (United States of America)

Worker Sub Type
Regular

Employee Entity
Abington Memorial Hospital Primary Location Address
2500 Maryland Road, Willow Grove, 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.

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