Clm Resltion Rep II, Hosp/Prv

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

905 Elmgrove Rd, Rochester, New York, United States of America, 14624

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

910402 United Business Office

Work Shift:

UR - Day (United States of America)

Range:

UR URCC 204 H

Compensation Range:

$19.72 - $26.62

Responsibilities:

GENERAL PURPOSE
The claims resolution representative II is responsible for working across the professional fee organization, performing routine follow-up activities designed to bring all open account receivables to successful closure. Responsible for effective claims follow-up to obtain maximum revenue collection. Responsibilities include but are not limited to researching, correcting, resubmitting claims, submitting appeals and taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative II reports to Accounts Receivable Management.

ESSENTIAL FUNCTIONS

With general direction of the Manager/Supervisor/Lead:

40% 

• Follows department policies and procedures and maintains and exercises thorough knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivables, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services.

25%

• Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc.
• Research claims, identifies problems, and takes appropriate action to assure claim resolution.

20%    

• Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner.
• Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing.
• Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims.

15%    

• Follows established procedure for missing insurance payment information on claims.
• Keeps management informed of trends.
• Remains current on changes in billing requirements associated with claim processing and coding.

5%      

• Escalate issues that may prevent completion of responsibilities to management. 

May perform other duties as assigned.

Required:

• High School diploma and 2 years of related work experience
• Or equivalent combination of education and experience.

Preferred:

• Strong working knowledge of the professional billing software applications
• Excellent customer service skills

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.