Business Office Representative

• Senior at Rochester Regional Health Business Office Representative
• Senior at Rochester Regional Health in Rochester, New York Posted in 8 days ago. $19.00
• $22.

50 per hour

Description Job Title:

Business Office Representative

•

Senior Department :

Ophthalmology Billing Location:

Riedman Campus, 100 Kings Highway, Rochester

NY 14617

Hours Per Week:

40

Schedule:

Full-Time, Day shift, Monday to Friday, (8 am

• 4:30 pm)

Position Summary:

Ensure full reimbursement is received by RRH for clinical services rendered including professional, long-term/home care and hospital care, by effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly and accurately in order to secure payment. As a Senior team member, create and document new processes and support denial analyses. Work as part of a dynamic team continually looking for ways to improve a complex business process.

Key Responsibilities:

Review and accurately process claim edits in a system workqueue. Accurately handle claim adjustments and coverage changes as needed. Review and process claim denials according to established processes. Research and resolve denial issues via the payer website, coverage policies and/or phone calls to the payer. Submit corrected claims and appeals. Process account adjustments and refunds as needed according to department policy and procedure. Document actions appropriately and follow-up with payers to ensure they take actions promised. Follow-up on claims with no responses. Manage large workload using tracking tools to ensure we don't fail to follow-up before a payer's deadline. Help lead team meetings which review new procedures, new denial types and system updates. Report problems and patterns to the supervisor to help keep policies and procedures up to date with new clinical programs and payer policy changes. Answer staff questions about processes and problem resolution. Acquire and maintain knowledge of system terminology, claim/denial/coverage concepts and terms, and relevant HIPAA privacy rules and other regulations. Expertly use insurance websites to explore denial issues and resolve them using the tools in Epic, including accessing clinical documentation and authorization details. Respond to patient complaints by researching coverage and claim processing to ensure the patient responsibility is accurate. Contact insurance as needed. Coordinate resolution with Customer Service staff. Create and maintain documentation of billing processes to support audits and training. Support denial trend analyses and special projects. Work directly with outside departments to assure authorizations, medical records, and appeals are accurate and timely Desired Attributes i. 2 years work experience in a healthcare setting preferred ii. Proficient working knowledge of assigned receivable systems iii. General knowledge of Medicare, Medicaid and insurance compliance issues preferred iv. Familiarity with ICD-9 diagnosis and procedure codes as well as

CPT/HCPCS

codes helpful v. Knowledge of UBO4 billing form and 1500F05 specific payor requirements preferred vi. Proficiency in a variety of computer applications and spreadsheet applications and common office equipment vii. Excellent problem solving, organizational and oral and written communication skills required viii. Strong communication, analytical and PC skills highly desired ix. Excellent interpersonal, organizational, communication, attention to detail and follow through skills x. Flexibility and ability to work as a team player and to handle simultaneous tasks xi. Successful completion of annual age and job specific competencies and skill verification tools required

Minimum Qualifications:

• None Required Licensure/Certification Skills:
• None Rochester General Health System is an Equal Opportunity / Affirmative Action Employer.

Minority/Female/Disability/Veteran

PHYSICAL REQUIREMENTS

Sedentary

• Sedentary roles are primarily office-based and require prolonged sitting (67-100% of the workday) with minimal physical effort and lifting limited to under 10 lbs.

Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver's license.

PAY RANGE

$19.00

• $22.

50 The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, clinical licensure date, relevant qualifications, specialty, internal equity, location, and contracts. Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.