Business Office Representative Senior

Rochester Regional Health; City of Rochester (NY); Vor Ort; USD 26.000 - 31.000; Vollzeit

Zusammenfassung

Rochester Regional Health is seeking a Senior Business Office Representative in Rochester, NY to ensure full reimbursement for clinical services by effectively managing receivables and resolving denials. The role involves using Epic to access clinical documentation and authorization details, along with cross-functional collaboration to improve processes.

The Senior team member will document new procedures, lead discussions on denial trends, and ensure timely payer actions.

Qualifikationen

• 2 years of work experience in a healthcare setting preferred.
• Proficient working knowledge of assigned receivable systems.
• General knowledge of Medicare, Medicaid, and insurance compliance issues preferred.
• Familiarity with ICD-9 diagnosis and procedure codes as well as CPT/HCPCS codes helpful.
• Knowledge of UBO4 billing form and 1500F05 specific payor requirements preferred.
• Proficiency in a variety of computer applications and spreadsheet applications and common office equipment.
• Excellent problem-solving, organizational, and oral and written communication skills required.
• Strong communication, analytical and PC skills highly desired.
• Excellent interpersonal, organizational, communication, attention to detail, and follow-through skills.
• Flexibility and ability to work as a team player and to handle simultaneous tasks.
• Successful completion of annual age and job-specific competencies and skill verification tools required.

Aufgaben

• Review and accurately process claim edits in a system work queue.
• 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

Kenntnisse

Healthcare experience

Receivables systems

Medicare/Medicaid knowledge

ICD-9/CPT knowledge

Office software (Excel)

Problem solving

Communication skills

Interpersonal skills

Team player

Attention to detail

Tools

Epic

Jobbeschreibung

Job Title: Senior Business Office Representative

Department: Financial Services

Location: Riedman Campus - 100 Kings Highway, Rochester, NY 14610

Hours Per Week: 40

Schedule: M-F; 7:00 AM to 3:30 PM, 7:30 AM to 4:00 PM, or 8:00 AM to 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 receivables. 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 work queue. 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

• 2 years of work experience in a healthcare setting preferred
• Proficient working knowledge of assigned receivable systems
• General knowledge of Medicare, Medicaid, and insurance compliance issues preferred
• Familiarity with ICD-9 diagnosis and procedure codes as well as CPT/HCPCS codes helpful
• Knowledge of UBO4 billing form and 1500F05 specific payor requirements preferred
• Proficiency in a variety of computer applications and spreadsheet applications and common office equipment
• Excellent problem-solving, organizational, and oral and written communication skills required
• Strong communication, analytical and PC skills highly desired
• Excellent interpersonal, organizational, communication, attention to detail, and follow-through skills
• Flexibility and ability to work as a team player and to handle simultaneous tasks
• 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 / Aff…

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