Business Office Representative

Unity-Hospital-of-Rochester; City of Rochester (NY); On-site; USD 2,549,000 - 3,065,000; Full time

Job summary

Rochester General Health System is seeking a Business Office Representative in Rochester, NY to support patient accounting and revenue integrity. The role involves examining claim edits, resolving denials, and posting remittances with Epic access.

You will work in a full-time day shift with a 40-hour week, aiming to ensure accurate reimbursements across hospital, professional, and home health services.

Qualifications

• At least one year experience in a Medical Office environment preferred.
• Knowledge of medical billing and insurance policies preferred.
• Excellent problem solving, organizational and oral and written communication skills.

Responsibilities

• Review and accurately process claim edits in a system workqueue.
• Review and process claim denials and adjustments as needed; research denials via payer websites or calls.
• Submit corrected claims and appeals; follow up with payers before deadlines.
• Document actions and ensure payer promises are followed; coordinate with customer service for patient issues.
• For Revenue Integrity: post remittances, scan/index remittances accurately, and identify postings per policy.

Skills

Problem solving

Organizational skills

Written and verbal communication

Tools

Epic

Job description

Job Title: Business Office RepresentativeDepartment: Patient AccountingLocation: Riedman Campus, 100 Kings Highway, Rochester NY 14617Hours Per Week: 40Schedule: Full-Time, Day Shift Monday to Friday-, Shift times can be 7:00 AM to 3:30 PM or 8:00 AM to 4:30 PMPosition 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 detailsDesired Attributes:i. Education/Training: At least one year experience in a Medical Office environment preferredii. Basic knowledge of medical billing, cording, collection processes, insurance policies and governmental regulation provision preferrediii. Knowledge of UBO4 billing form and 1500F05 specific payer requirements preferrediv. Excellent problem solving, organizational and oral and written communication skills requiredv. Successful completion of annual age and job specific competencies and skill verification tools requiredvi. Proficiency in a variety of computer applications and spreadsheet applications and common office equipmentMinimum Qualifications:•NoneRequired Licensure/Certification Skills:•NoneRochester General Health System is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/VeteranEDUCATION: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 - $22.25CITY:RochesterPOSTAL CODE:14617The 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.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.