Business Office Representative - Senior

Rochester Regional Health

3d•$19 - $23•Onsite

About The Position

The Business Office Representative - Senior works in Patients Accounts to ensure Rochester Regional Health receives full reimbursement for clinical services, including professional, long-term/home care, and hospital care. The role manages receivables, resolves claim edits, and researches denials and payer requests so accurate claims are submitted and payment is secured. As a senior team member, this position helps lead team meetings, answers staff questions, documents billing processes, supports denial analysis and special projects, and helps keep procedures current. The representative also coordinates with other departments and Customer Service to resolve authorizations, medical records, appeals, and patient billing concerns. This is a full-time, day-shift position at the Riedman Campus in Rochester, New York, scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m., for 40 hours per week.

Requirements

Excellent problem-solving, organizational, oral and written communication skills.
Excellent interpersonal skills, attention to detail, and follow-through.
Ability to communicate and analyze information effectively and strong PC skills.
Flexibility and ability to work as a team player while handling simultaneous tasks.
Successful completion of annual age- and job-specific competencies and skill verification tools.
Ability to meet the stated sedentary physical demands, including prolonged sitting and computer, writing, and telephone work.

Nice To Haves

Two years of work experience in a healthcare setting.
Proficient working knowledge of assigned receivable systems.
General knowledge of Medicare, Medicaid, and insurance compliance issues.
Familiarity with ICD-9 diagnosis and procedure codes and CPT/HCPCS codes.
Knowledge of UB-04 billing form and 1500F05 specific payer requirements.
Proficiency with computer and spreadsheet applications and common office equipment.

Responsibilities

Review and accurately process claim edits in a system workqueue; handle claim adjustments and coverage changes as needed.
Review and process claim denials, research denial issues through payer websites, coverage policies, or phone calls, and submit corrected claims and appeals.
Process account adjustments and refunds according to department policy and procedure.
Document actions and follow up with payers on promised actions and unanswered claims; use tracking tools to meet payer deadlines.
Help lead team meetings covering procedures, denial types, and system updates.
Report problems and patterns to the supervisor and answer staff questions about processes and problem resolution.
Maintain knowledge of system terminology, claims, denials, coverage concepts, HIPAA privacy rules, and other relevant regulations.
Use insurance websites and Epic tools, including clinical documentation and authorization details, to investigate and resolve denial issues.
Research coverage and claim processing in response to patient complaints, contact insurers as needed, and coordinate resolution with Customer Service staff.
Create and maintain billing-process documentation for audits and training; support denial trend analyses and special projects.
Work with outside departments to ensure authorizations, medical records, and appeals are accurate and timely.