Dearia Harris

The Medical Management Specialist I is responsible for providing non-clinical support to the Medical Management and/or Operations areas.

• Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
• Provides information regarding network providers or general program information when requested.
• May assist with complex cases.
• May act as liaison between Medical Management and/or Operations and internal departments.
• Maintains and updates tracking databases.
• Prepares reports and documents all actions.
• Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.

A Revenue Cycle Representative at UNC Health Care is responsible for various tasks within the revenue cycle, including accurate and timely claim submission, insurance follow-up, and collections. They also handle claim denials, re-billing, and resolving discrepancies.

• Claim Submission and Follow-up: Accurately and timely submit claims, respond to denials, and re-bill insurance claims.
• Insurance Follow-up and Collections: Manage all aspects of insurance follow-up and collections, including internal and external communication to resolve discrepancies.
• Claim Editing: Edit claims to ensure compliance with billing guidelines.
• Patient Financial Services: Address patient inquiries, explain billing procedures, and manage patient payment plans.
• Estimate Creation: Create and manage patient estimates, educating patients on their financial responsibilities.
• Payment Plan Management: Manage patient payment plans, including outreach on delinquent accounts.
• Patient Relations and Risk Management: Work with related departments to resolve escalated patient complaints.