Business Office Representative - Senior

Rochester Regional Health

About The Position

The Business Office Representative - Senior is responsible for ensuring full reimbursement for clinical services rendered by RRH, including professional, long-term/home care, and hospital care, through effective and accurate management of receivables. This role involves resolving edits to ensure accurate claims are sent to primary and secondary insurances, and promptly researching and resolving denials and payer requests for information to secure payment. As a Senior team member, the individual will also be involved in creating and documenting new processes and supporting denial analyses, working collaboratively to continuously improve complex business processes.

Requirements

Proficiency in a variety of computer applications and spreadsheet applications and common office equipment
Excellent problem solving, organizational and oral and written communication skills
Excellent interpersonal, organizational, communication, attention to detail and follow through skills
Flexibility and ability to work as a team player and to handle simultaneous tasks
Successful completion of annual age and job specific competencies and skill verification tools

Nice To Haves

2 years work experience in a healthcare setting preferred
Proficient working knowledge of assigned receivable systems
General knowledge of Medicare, Medicaid and insurance compliance issues preferred
Familiarity with ICD-9 diagnosis and procedure codes as well as CPT/HCPCS codes helpful
Knowledge of UBO4 billing form and 1500F05 specific payor requirements preferred
Strong communication, analytical and PC skills highly desired

Responsibilities

Review and accurately process claim edits in a system workqueue
Accurately handle claim adjustments and coverage changes as needed
Review and process claim denials according to established processes
Research and resolve denial issues via the payer website, coverage policies and/or phone calls to the payer
Submit corrected claims and appeals
Process account adjustments and refunds as needed according to department policy and procedure
Document actions appropriately and follow-up with payers to ensure they take actions promised
Follow-up on claims with no responses
Manage large workload using tracking tools to ensure we don’t fail to follow-up before a payer’s deadline
Help lead team meetings which review new procedures, new denial types and system updates
Report problems and patterns to the supervisor to help keep policies and procedures up to date with new clinical programs and payer policy changes
Answer staff questions about processes and problem resolution
Acquire and maintain knowledge of system terminology, claim/denial/coverage concepts and terms, and relevant HIPAA privacy rules and other regulations
Expertly use insurance websites to explore denial issues and resolve them using the tools in Epic, including accessing clinical documentation and authorization details
Respond to patient complaints by researching coverage and claim processing to ensure the patient responsibility is accurate
Contact insurance as needed
Coordinate resolution with Customer Service staff
Create and maintain documentation of billing processes to support audits and training
Support denial trend analyses and special projects
Work directly with outside departments to assure authorizations, medical records, and appeals are accurate and timely