Clm Resltion Rep II, Hosp/Prv

University of Rochester•Rochester, NY

86d•Remote

About The Position

The claims resolution representative II is responsible for working across the professional fee organization, performing routine follow-up activities designed to bring all open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Responsibilities include but are not limited to researching, correcting, resubmitting claims, submitting appeals and taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative II reports to Accounts Receivable Management. With general direction of the Manager/Supervisor/Lead: Follows department policies and procedures and maintains and exercises thorough knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivables, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services. Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Researches claims, identifies problems, and takes appropriate action to assure claim resolution. Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims. Follows established procedure for missing insurance payment information on claims. Keeps management informed of trends. Remains current on changes in billing requirements associated with claim processing and coding. Escalate issues that may prevent completion of responsibilities to management. May perform other duties as assigned.

Requirements

High School diploma and 2 years of related work experience required.

Nice To Haves

Associate degree preferred
Ability to problem solve preferred
Excellent communication skills preferred
Ability to put information into a keyboard while typing min of 25 wpm preferred.
Strong working knowledge of the professional billing software applications preferred
Excellent customer service skills preferred

Responsibilities

Perform routine follow-up activities designed to bring all open account receivables to successful closure.
Ensure effective claims follow-up to obtain maximum revenue collection.
Research, correct, and resubmit claims.
Submit appeals for unpaid claims.
Take timely and routine action to resolve unpaid claims.
Follow department policies and procedures.
Maintain thorough knowledge of insurance company billing requirements and regulations.
Research and resolve unpaid accounts receivables.
Make necessary corrections in the professional billing system.
Follow up on denied accounts through review of remittances (EOBs), insurance correspondence, and rejections.
Research claims, identify problems, and take appropriate action to assure claim resolution.
Respond to billing-related inquiries from colleagues, departments, patients, and payors.
Communicate missing/incomplete information to providers and department administrative support staff.
Communicate with insurance representatives through telephone calls, payer website, and written communication.
Follow established procedure for missing insurance payment information on claims.
Keep management informed of trends.
Remain current on changes in billing requirements associated with claim processing and coding.
Escalate issues that may prevent completion of responsibilities to management.
May perform other duties as assigned.