Business Office Representative

Rochester Regional Health; City of Rochester (NY); On-site; USD 25,000 - 31,000; Full time

Job summary

Rochester Regional Health is seeking a Senior Business Office Representative at the Riedman Campus in Rochester, NY to ensure full reimbursement for clinical services by managing receivables and resolving denials. You will work with payers to secure payment, post payments, and handle adjustments.

Responsibilities include processing claim edits, denials, and corrections, researching payer issues, and coordinating with Customer Service.

Qualifications

• At least one year experience in a Medical Office environment preferred.
• Basic knowledge of medical billing, coding, collection processes, insurance policies and governmental regulation provisions preferred.
• Knowledge of UBO4 billing form and 1500F05 specific payer requirements preferred.
• Excellent problem solving, organizational and oral and written communication skills required.
• Successful completion of annual age and job specific competencies and skill verification tools required.
• Proficiency in a variety of computer applications and spreadsheet applications and common office equipment.

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.
• Coordinate resolution with Customer Service staff.

Skills

Medical office experience

Medical billing knowledge

UBO4/1500F05 payer requirements

Problem solving

Communication skills

Computer & spreadsheet proficiency

Job description

Business Office Representative -Senior Department: Patients Accounts 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. 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.
• Participate in 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.
• 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.
• For Revenue Integrity: For team members who are responsible for completing payment posting: research and resolve payment posting requests/discrepancies in order to properly relieve the receivable Review and accurately scan/index remittances and correspondence Identify and accurately post remittances for all payors to correct accounts/systems according to department policy and procedure Expertly use insurance websites to explore denial and payment issues and resolve them using the tools in Epic, including accessing clinical documentation and authorization details.

Desired Attributes

• i. Education/Training: At least one year experience in a Medical Office environment preferred
• ii. Basic knowledge of medical billing, cording, collection processes, insurance policies and governmental regulation provision preferred
• iii. Knowledge of UBO4 billing form and 1500F05 specific payer requirements preferred
• iv. Excellent problem solving, organizational and oral and written communication skills required
• v. Successful completion of annual age and job specific competencies and skill verification tools required
• vi. Proficiency in a variety of computer applications and spreadsheet applications and common office equipment

Minimum Qualifications

None Required Licensure/Certification Skills: None EDUCATION: LICENSES / CERTIFICATIONS:

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. For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements. Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE

$18.50 - $22.25 CITY: Rochester POSTAL CODE: 14617 The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components. Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, and contracts.

Equal Opportunity Employer

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.

Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes, St. Lawrence County, and beyond. The system includes nine hospitals; primary and specialty practices, rehabilitation centers, ambulatory campuses and immediate care facilities; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and Rochester Regional Health Laboratories and ACM Global Laboratories, a global leader in patient and clinical trials. It’s vision is to lead the evolution of healthcare to enable every member of the communities it serves to enjoy a better, healthier life.