Business Office Representative

Rochester Regional Health

1d•$19 - $22•Onsite

About The Position

The Business Office Representative works in Financial Services to ensure Rochester Regional Health receives full reimbursement for clinical services, including professional, long-term and home care, and hospital care. The role manages receivables, resolves claim edits, and ensures accurate claims are submitted to primary and secondary insurers. It researches and resolves denials and payer requests for information promptly to secure payment, while contributing to a team focused on improving complex business processes. The representative may also perform Revenue Integrity payment-posting work, including researching discrepancies and requests, scanning and indexing remittances and correspondence, and posting payer remittances to the correct accounts and systems. The position uses payer websites and Epic tools, including access to clinical documentation and authorization details. It also responds to patient complaints by investigating coverage and claim processing and coordinating with Customer Service. The position is based at the Riedman Campus in Rochester, New York, and is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m., for 40 hours per week. The role is classified as sedentary, with prolonged sitting, computer and telephone work, and limited lifting. The pay range is $18.50–$22.25.

Requirements

Excellent problem-solving, organizational, oral communication, and written communication skills.
Successful completion of annual age- and job-specific competencies and skill verification tools.
Proficiency with computer applications, spreadsheet applications, and common office equipment.
Ability to perform sedentary office work involving prolonged sitting, fine motor tasks for computer, writing, and telephone use, and sustained concentration and information processing.

Nice To Haves

At least one year of experience in a medical office environment.
Basic knowledge of medical billing, coding, collection processes, insurance policies, and governmental regulatory provisions.
Knowledge of UB-04 billing forms and 1500/F05 specific payer requirements.

Responsibilities

Review and accurately process claim edits in a system workqueue, including claim adjustments and coverage changes.
Review and process claim denials according to established procedures; research issues through payer websites, coverage policies, and phone calls; and submit corrected claims and appeals.
Process account adjustments and refunds in accordance with department policies and procedures.
Document actions and follow up with payers on promised actions and unanswered claims; use tracking tools to manage workload and meet payer deadlines.
Participate in team meetings about procedures, denial types, and system updates, and report problems and patterns to the supervisor.
Maintain knowledge of system terminology, claims, denials, coverage concepts, HIPAA privacy rules, and other relevant regulations.
Use insurance websites and Epic tools to investigate and resolve denial issues, including by accessing clinical documentation and authorization details.
Research patient complaints about coverage and claim processing, contact insurers as needed, and coordinate resolution with Customer Service staff.
For team members assigned payment-posting duties, research and resolve payment-posting requests and discrepancies to properly relieve receivables.
Accurately scan and index remittances and correspondence.
Identify and accurately post payer remittances to the correct accounts and systems in accordance with department policy and procedure.
Use insurance websites and Epic tools to investigate denial and payment issues, including by accessing clinical documentation and authorization details.