Business Office Representative Senior

Rochester Regional Health

1d•$19 - $23•Onsite

About The Position

The Senior Business Office Representative works in Financial Services to ensure full reimbursement to Rochester Regional Health for clinical services, including professional, long-term/home care, and hospital care. The role manages receivables, resolves claim edits, and helps ensure accurate claims are submitted to primary and secondary insurers. It researches payer denials and requests for information, submits corrected claims and appeals, and follows up to secure payment. As a senior team member, this role helps lead team meetings, answers staff questions, documents billing processes, supports denial trend analyses and special projects, and reports problems and patterns to the supervisor. It works with outside departments to ensure authorizations, medical records, and appeals are accurate and timely, and coordinates with Customer Service to investigate patient complaints and verify patient responsibility. The position requires maintaining knowledge of relevant systems, payer and coverage concepts, and HIPAA privacy rules and other regulations. The position is listed at the Riedman Campus in Rochester, New York, with a 40-hour workweek and one of three weekday schedules: 7:00 AM–3:30 PM, 7:30 AM–4:00 PM, or 8:00 AM–4:30 PM. The role is sedentary and primarily office-based, with prolonged sitting and computer, writing, and telephone work. The posted pay range is $19.00–$22.50.

Requirements

Minimum qualifications: None listed.
Required licensure/certification skills: None listed.
Excellent problem-solving, organizational, oral and written communication skills.
Strong communication, analytical, and personal computer skills.
Excellent interpersonal skills, attention to detail, and follow-through.
Flexibility, ability to work as a team player, and ability to handle simultaneous tasks.
Successful completion of annual age- and job-specific competencies and skill verification tools.

Nice To Haves

Two years of work experience in a healthcare setting preferred.
Proficient working knowledge of assigned receivable systems.
General knowledge of Medicare, Medicaid, and insurance compliance issues preferred.
Familiarity with ICD-9 diagnosis and procedure codes and CPT/HCPCS codes helpful.
Knowledge of UB04 billing form and 1500F05 specific payer requirements preferred.
Proficiency in a variety of computer and spreadsheet applications and common office equipment.

Responsibilities

Review and accurately process claim edits in a system work queue, including claim adjustments and coverage changes.
Review and process claim denials; research issues through payer websites, coverage policies, or calls to payers; and submit corrected claims and appeals.
Process account adjustments and refunds according to department policies and procedures.
Document actions and follow up with payers on promised actions and claims that have received no response; use tracking tools to meet payer deadlines.
Help lead team meetings that review procedures, denial types, and system updates.
Report problems and patterns to the supervisor to help keep policies and procedures current with clinical programs and payer policy changes.
Answer staff questions about processes and problem resolution.
Maintain knowledge of system terminology, claim, denial, and coverage concepts, HIPAA privacy rules, and other relevant 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 insurers as needed, and coordinate resolution with Customer Service staff.
Create and maintain billing-process documentation for audits and training, and support denial trend analyses and special projects.
Work with outside departments to ensure authorizations, medical records, and appeals are accurate and timely.
Complete annual age- and job-specific competencies and skill verification tools.