Opening
Full Time 40 hours Range URC 205 Patient Financial Services
Schedule
7 AM-4:30 PM
Responsibilities
Location:
Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at RTP are required. Remote location must be within 2 hours of RTP and within New York State.
Position Summary:
With latitude for initiative and independent judgment within department guidelines, the position is responsible for managing professional hospital accounts. Activities performed will focus on resolving balances of aged insurance accounts which have not been collected through routine billing and collection activities. Claim Resolution Rep III will make independent decisions as to the processes necessary to collect denied insurance claims, no response accounts, and will investigate resolving billing issues. Maintain a detailed knowledge of billing requirements and regulations to ensure that the process conforms to federal and state regulations bringing concerns to the attention of billing Manager and Supervisor. The Claim Resolution Rep III will represent the department and Strong Memorial Hospital (SMH) in a professional manner, protecting confidentiality of patient information at all times.
Supervision and Direction Exercised:
The Claim Resolution Rep III is responsible for self-monitoring performance on assigned tasks, following standard procedures as directed by the Supervisor or Manager.
Machines and Equipment Used:
Standard office equipment, including but not limited to: telephone, photocopy machine, adding machine, personal computer (for claims inquiry and entry software) fax/scanner, Microsoft Word, Excel, Access, Email, third party claims systems (ePaces, Connex), Epic Billing System, and various payer web sites.
Typical Duties:
40% Completes follow up activities on denied, unpaid, or under-paid accounts by use of EPIC Insurance Coverage or the Payer Website link, online systems with insurance companies, and other third-party payers to obtain payments, as well as contact payer representatives to research/resubmit rejected claims to obtain and verify insurance coverage.
30% Maintains a thorough knowledge of Professional Billing to include understanding of policies and procedures related to insurance collection and follow up.
15% Identify and clarify billing issues, payment variances and/or trends that require management intervention; share with Supervisor and/or Manager. Assist Supervisor with credit balance account review/resolution and all audits
10% Research and respond to third party correspondence, receive phone calls, explain policies and procedures involving routine and non-routine situations. Assist with patient related questions. Communicates with other URMFG, HIM, Revenue Integrity, Registration and Insurance Management, PFS, EPIC Single Billing Office, and SMH departments.
5% Other miscellaneous duties
Expectations:
Qualifications:
Associate's degree in Business Administration and 2 years of hospital/professional Patient Accounting, Consumer Collections experience, or Certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience. Ability to type 25 wpm
The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion 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 status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled
Pay Range
Pay Range: $19.14 - $25.84 Hourly
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined byconsidering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.