Business Office Representative

Rochester Regional Health

3d•$19 - $22•Onsite

About The Position

The Business Office Representative ensures full reimbursement to Rochester Regional Health for clinical services, including professional, long-term and home care, and hospital care. The role manages receivables, resolves claim edits, denials and payer requests for information, and works to submit accurate claims and secure payment. It also supports a team working to improve complex business processes. The position may include Revenue Integrity payment-posting responsibilities, such as researching payment discrepancies, processing remittances and correspondence, and posting payments to the correct accounts and systems. The representative uses payer websites and Epic tools to investigate claim, denial and payment issues, including reviewing clinical documentation and authorization details.

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.

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 regulation provisions.
Knowledge of UB-04 billing forms and 1500F05 specific payer requirements.

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 issues using payer websites, coverage policies or payer 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 to confirm promised actions, pursue claims with no response, and track work to meet payer deadlines.
Participate in team meetings concerning new procedures, denial types and system updates.
Report problems and patterns to the supervisor to help maintain current policies and procedures in response to clinical programs and payer policy changes.
Maintain knowledge of system terminology, claim, denial and coverage concepts, HIPAA privacy rules and other relevant regulations.
Use insurance websites and Epic tools to investigate denial issues, including 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 responsible for payment posting, research and resolve payment-posting requests and discrepancies to properly relieve receivables.
Review, scan and index remittances and correspondence accurately.
Identify and accurately post remittances for all payors to the correct accounts and systems according to department policy and procedure.
Use insurance websites and Epic tools to investigate denial and payment issues, including accessing clinical documentation and authorization details.