Claim Resolution Rep IV

University of Rochester • Town of Gates, NY

90d • $20 - $28

About The Position

The University of Rochester is seeking a dedicated individual to join the Patient Financial Services team. This position involves performing follow-up activities designed to bring all open account receivables to successful closure and obtain maximum revenue collection. The role includes researching, correcting, resubmitting claims, submitting appeals, and taking timely action to resolve unpaid claims. The successful candidate will also mentor and train new or lower-level staff. The position is based at the Rochester Tech Park (RTP) in Gates, NY, with remote options available after in-person training, although occasional onsite meetings/work at RTP are required. Remote locations must be within 2 hours of RTP and within New York State.

Requirements

• Associate's degree and 3 years of relevant experience required.
• Equivalent combination of education and experience may be considered.

Responsibilities

• Independently determines the most effective method to follow up on disputed, unpaid, underpaid, or overpaid insurance or contracted service accounts.
• Identifies and resolves problems related to primary and secondary accounts which are disputed, unpaid, underpaid or overpaid.
• Determines cause of problem and initiates corrective action through reviews of electronic medical records.
• Works to confer with external agencies.
• Analyzes accounts and determines if correct proration of revenue has been collected.
• Contacts applicable agency, payer or department for resolution.
• Decides when resubmitting efforts are complete, including writing an appeal using applicable content and supporting documentation.
• Acts as a resource for questions from assigned collection and billing staff on payer policies, procedures and methods of revenue collection.
• Trains new staff on the use of the billing application, payer systems, and clearinghouse systems.
• Provides feedback to leadership on results of training of new and existing staff.
• Acts as area leader, when needed, including responding to payers, patients, and issues referred to the area from hospital departments.
• Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts.
• Assesses if/when patients are contacted.
• Resolves complex, high dollar, and specialized claim resolution issues.
• Researches, verifies, and/or obtains authorizations post-claim submittal.
• Determines allocation of reimbursement applicable to multiple providers for global transplant payments.
• Identifies need for in-person meetings and phone conferences with third party insurance representatives.
• Prepares information for and attends meetings with third-party insurance representatives.
• Identifies and clarifies issues that require management and intervention.
• Recommends filing of a formal complaint with the State’s regulation commission or agency.
• Determines when to change the account to a self-pay financial class.
• Research and initiates suggestions to leadership to streamline processes and training materials.
• Performs coverage for other positions as needed.
• Performs administrative office tasks and maintains records.
• Other duties as assigned.

Benefits

• Competitive salary range of $20.99 - $28.34 per hour.
• Full-time position with 40 scheduled weekly hours.
• Opportunities for professional development and training.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees