Clm Resltion Rep III, Hosp/Prv Position Available In Albany, New York

Clm Resltion Rep III, Hosp/Prv
Albany, NY
As amunity, the University of Rochester is defined by a deepmitment to Meliora•Ever Better. Embedded in that ideal are the values we : equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure ourmunity is weing to all and is a place w all can thrive. Job Location (Full Address): Remote Work•New York, Albany, New York, United States of America, 12224

Opening:

Worker Subtype:

Regular Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

910402

United Business Office Work Shift:

UR•Day (United States of America)

Range:

UR URC 205 H

Compensation Range:

$19.62•$26.49 The referenced pay range represents the minimum and maximumpensation for this job. Individual annual salaries/hourly rates will be set within the job’spensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

GENERAL PURPOSE

The Claims Resolution Representative III is responsible for working across the professional feeanization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up onplex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management.

ESSENTIAL FUNCTIONS

With general direction of the

Manager/Supervisor/Lead:

40% Follows department policies and procedures and maintains and exercisesprehensive knowledge of insurancepany billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services. 25% Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims, identify problems, and take appropriate action to assure claim resolution. 20% Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. Communicates any missing/iplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer , and writtenmunication to ensure accurate processing of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurancepanies. 10% Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. 5% Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate. May perform other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

Required:

Associate degree and 2 years of related relevant experience; or equivalentbination of education and/or experience Excellent problem solving skills Excellentmunication skills Excellent customer service skills

Preferred:

Strong working knowledge of the professional billing software applications Ability to type 25 wpm. The University of Rochester ismitted to fostering, cultivating, and preserving an inclusive and weing culture to advance the University’s Mission to Learn, Discover, Heal, Create•and Make the World Ever Better. In support of our values and those of our society, the University ismitted to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). Thismitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

Notice:

If you are a Current Employee, please log into myURHR to search for and to jobs using the Jobs Hub. Your application, if submitted using this portal, cannot be moved forward. Learn. Discover. Heal. Create. Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better. If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals At the University of Rochester, we aremitted to fostering, cultivating, and preserving an inclusive and weing culture and are united by a strongmitment to be ever better—Meliora. It is an ideal that informs our d mission to ensure all members of ourmunity feel safe, respected, included, and valued.