Responsibilities

Job Summary:

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.

Key Functions and Expected Performances:

With general direction of the Manager/Supervisor/Lead:

40% 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.

25% Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Researches claims, identifies problems, and takes 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/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.

15% 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.

5% Escalate issues that may prevent completion of responsibilities to management.

May perform other duties as assigned.

Qualifications:

• Required:

1. Associate degree and 2 years of related relevant experience; or equivalent combination of education and/or experience

2. Ability to problem solve

3. Excellent communication skills

4. Ability to put information into a keyboard while typing min of 25 wpm.

• Preferred:

1. Strong working knowledge of the professional billing software applications

2. Excellent customer service skills

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion 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 is committed 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 status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $18.71 - $25.27 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation 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.

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Location: Medical Faculty Group
Full/Part Time: Full-Time
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