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/home care, and hospital care. The role manages receivables by resolving claim edits, denials, and payer requests for information so accurate claims are submitted and payment is secured. The representative works as part of a team focused on improving complex business processes. The position is based at the Riedman Campus in Rochester, New York, and is scheduled for 40 hours per week, Monday through Friday, with either a 7:00 AM–3:30 PM or 8:00 AM–4:30 PM schedule. The posted 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 a variety of computer and 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 regulatory provisions.
Knowledge of UB-04 billing forms and 1500F05 specific payer requirements.

Responsibilities

Review and accurately process claim edits in a system work queue, including claim adjustments and coverage changes.
Review and process claim denials according to established processes; research and resolve issues through payer websites, coverage policies, and phone calls.
Submit corrected claims and appeals.
Process account adjustments and refunds according to department policy and procedure.
Document actions, follow up with payers on promised actions, and 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 about procedures, denial types, and system updates.
Report problems and patterns to the supervisor to help maintain policies and procedures as clinical programs and payer policies change.
Maintain knowledge of system terminology, claim, denial, and coverage concepts, HIPAA privacy rules, and other regulations.
Use insurance websites and Epic tools, including clinical documentation and authorization details, to investigate and resolve denial issues.
Research patient complaints about coverage and claim processing, contact insurance as needed, and coordinate resolution with Customer Service staff.