Clm Resltion Rep III, Hosp/Prv

University of Rochester•Rochester, MN

14d•$20 - $27•Onsite

About The Position

The Claims Resolution Representative III performs follow-up activities to bring open accounts receivable to successful closure and maximize revenue collection. The role researches and resolves complex claims, corrects and resubmits claims, submits appeals, and takes timely action to resolve unpaid claims. It also serves as a resource for lower-level staff. The representative follows up on denied, unpaid, and underpaid accounts; investigates claim denials with payers; determines and documents steps needed to secure payment; and resolves incorrectly paid claims. The role bills primary and secondary insurance claims, reviews insurance credits and credit balances, supports audits, and identifies billing issues, payment variances, and trends requiring management attention. It also responds to third-party correspondence and calls, assists with patient questions, and coordinates with other departments to resolve claim issues. The position is in the Patient Financial Services department at 905 Elmgrove Rd, Rochester, New York. It is a regular, full-time role scheduled for 40 hours per week on the UR Day shift. The compensation range is $20.30–$27.41; the posting notes that individual rates are determined based on factors including market data, education, experience, qualifications, expertise, and internal equity.

Requirements

Associate's degree and 2 years of relevant experience, or an equivalent combination of education and experience.

Responsibilities

Complete follow-up on denied, unpaid, and underpaid accounts and contact payer representatives to research claims and verify insurance coverage.
Review claim denial reasons and payer information, determine actions needed to secure payment, and document follow-up, including resubmitting claims or deferring tasks.
Research and calculate underpaid or overpaid claims and determine final resolution.
Contact payers to resolve incorrectly paid claims and complete adjudication; adjust accounts or process insurance refund credits.
Review and advise leadership about incorrectly paid claims from specific payers, and work with leadership on payer communications about payment trends and issues.
Bill primary and secondary claims to insurance.
Identify billing issues, payment variances, and trends that require management intervention.
Assist department leadership with credit-balance account reviews and resolutions, audits, and responses to Medicaid and Medicare credit balances.
Request insurance adjustments or retractions and review and work insurance credits in the electronic health record.
Enter notes in the electronic health record documenting actions taken.
Research and respond to third-party correspondence, receive phone calls, and explain policies and procedures in routine and non-routine situations.
Assist with patient-related questions and coordinate with other departments to resolve claim issues.
Perform other duties as assigned.