Business Office Representative Senior

Rochester General Hospital; United States; On-site; USD 26,000 - 31,000; Full time

Job summary

Rochester General Hospital is seeking a Senior Business Office Representative in Rochester, NY, to ensure full reimbursement for clinical services by effectively managing receivables. You will resolve claim edits, investigate denials, and support denial analyses within Epic and payer portals.

The role requires leading process improvements, coordinating with insurance and patient services, and maintaining documentation for audits, with a 40-hour workweek on site at the Riedman Campus.

Qualifications

• 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 CPT/HCPCS codes helpful
• Knowledge of UBO4 billing form and 1500F05 payor requirements preferred
• Proficiency in common office applications and spreadsheets
• 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

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.

Job description

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

• i. 2 years of 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 / Affitting 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.

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

$19.00 - $22.50

CITY: Rochester

POSTAL CODE: 14617