Clm Resltion Rep III, Hosp/Prv
- Role
- Operations
- Experience
- Mid
- Employment
- Full-time
Open to US only. Set where you work from to check your eligibility.
No BS summary
Experienced medical claims/accounts receivable specialist (Claims Resolution Rep III) with 2+ years' relevant experience and an Associate's degree or equivalent. Remote within New York (candidate must be in New York); will perform complex claim research, corrections, resubmissions and payer appeals for professional-fee physician services. Requires strong knowledge of professional billing systems and effective payer/patient communication.
Core skills
Required skills
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): Remote Work - New York, Albany, New York, United States of America, 12224 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 URCA 205 H Compensation Range: $20.30 - $27.41 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 by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations. Responsibilities: The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management. ESSENTIAL FUNCTIONS With general direction of the Manager/Supervisor/Lead: Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to r esearch and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services. Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims, identify problems, and takes appropriate action to assure claim resolution. 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. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate. May perform other duties as assigned. MINIMUM EDUCATION & EXPERIENCE Associate's degree and 2 years of relevant experience required Or equivalent combination of education and experience KNOWLEDGE, SKILLS AND ABILITIES Excellent problem-solving skills preferred Excellent communication skills preferred Excellent customer service skills preferred Strong working knowledge of the professional billing software applications preferred Ability to type 25 wpm preferred. 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.
What you'll do
- Work across the professional fee organization handling follow-up activities to bring open accounts receivable to closure.
- Perform effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure.
- Independent research, claim correction and resubmission, and handling payer-specific appeal processes to resolve unpaid claims.
- Follow department policies and procedures and maintain comprehensive knowledge of insurance billing requirements and regulations to research and resolve unpaid accounts receivable for assigned URMFG physician services.
- Follow up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, and electronic claim rejections.
- Research claims, identify problems, and take appropriate action to assure claim resolution.
- Respond to billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner.
- Communicate missing/incomplete information to providers and department administrative support staff to ensure accurate billing.
- Communicate with insurance representatives via telephone, payer websites, and written communication to ensure accurate processing of claims.
- Collaborate with appropriate departments to generate detailed rationale for appeals and grievances to insurance companies.
- Keep management informed of changes in billing requirements and rejection/denial codes relevant to claim processing and coding.
- Escalate system issues preventing claims submission and follow-up for review and resolution.
- Collaborate with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre-claim WQs to identify opportunities to improve clean claims rate.
- May perform other duties as assigned.
- Reports to Accounts Receivable Management.
What they require
- Associate's degree and 2 years of relevant experience required Or equivalent combination of education and experience
- Preferred: Excellent problem-solving skills
- Preferred: Excellent communication skills
- Preferred: Excellent customer service skills
- Preferred: Strong working knowledge of professional billing software applications
- Preferred: Ability to type 25 wpm
private, nonsectarian, research university in Rochester, New York, United States