Clm Resltion Rep II, Hosp/Prv
About The Position
As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. 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.
Requirements
- High School Diploma and 2 years of related work experience or equivalent combination of education and/or experience
Nice To Haves
- Strong working knowledge of the professional billing software applications
- Excellent customer service skills
Responsibilities
- 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. Research 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
51-100 employees
