Business Office Representative

Rochester Regional Health

3d•$19 - $22•Onsite

About The Position

The Business Office Representative ensures Rochester Regional Health receives full reimbursement for clinical services, including professional, long-term and home care, and hospital care, by effectively and accurately managing receivables. The role resolves claim edits to ensure accurate claims are sent to primary and secondary insurers, and researches and resolves denials and payer requests for information promptly and accurately to secure payment. The representative works as part of a team focused on improving complex business processes. For team members responsible for payment posting in Revenue Integrity, the role also includes researching and resolving payment-posting requests and discrepancies, reviewing and indexing remittances and correspondence, and accurately posting remittances for all payors to the correct accounts and systems.

Requirements

Excellent problem-solving, organizational, oral, and written communication skills.
Successful completion of annual age- and job-specific competencies and skill-verification tools.
Proficiency in a variety of 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 work queue.
Handle claim adjustments and coverage changes as needed.
Review and process claim denials according to established processes.
Research and resolve denial issues using payer websites, coverage policies, and phone calls to payers; submit corrected claims and appeals.
Process account adjustments and refunds according to department policy and procedure.
Document actions and follow up with payers to ensure promised actions are completed; follow up on claims without responses.
Manage a large workload using tracking tools to ensure follow-up occurs before payer deadlines.
Participate in team meetings covering new procedures, denial types, and system updates.
Report problems and patterns to the supervisor to help keep policies and procedures current with 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 and resolve denial issues, including accessing clinical documentation and authorization details.
Research patient complaints about coverage and claim processing to ensure patient responsibility is accurate; contact insurers 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.
For team members responsible for payment posting: scan and index remittances and correspondence accurately.
For team members responsible for payment posting: identify and post remittances for all payors to the correct accounts and systems according to department policy and procedure.
For team members responsible for payment posting: use insurance websites and Epic tools to investigate denial and payment issues, including accessing clinical documentation and authorization details.