Clm Resltion Rep II, Hosp/Prv

001 University of Rochester; New York (NY); Hybrid; USD 27,000 - 37,000; Full time

Job summary

The University of Rochester is seeking a Claims Resolution Representative II for the United Business Office. This remote role supports the professional fee organization across open accounts receivable, focusing on maximum revenue through diligent follow-up and accurate claim processing.

Responsibilities include researching, correcting, resubmitting claims, submitting appeals, and communicating with payors. Excellent communication, problem solving, and billing software proficiency are required.

Qualifications

• High School diploma and 2 years of related work experience required.
• Associate degree preferred or an equivalent combination of education and experience.
• Experience with professional billing software applications preferred.

Responsibilities

• Perform claims follow-up to maximize revenue collection.
• Research, correct, resubmit claims and submit appeals.
• Escalate issues to management as needed and keep stakeholders informed.

Skills

Problem solving

Communication

Typing speed 25 wpm

Billing software

Customer service

Education

High School diploma / equivalent

Associate degree preferred

Job description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address): Remote Work - New York, Albany, New York, United States of America, 12224

Opening: Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910402 United Business Office Work Shift: UR - Day (United States of America)

Range: UR URCC 204 H

Compensation Range: $19.72 - $26.62

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.

Responsibilities

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.

Essential Functions

With general direction of the Manager/Supervisor/Lead: 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. 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. 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. 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. Escalate issues that may prevent completion of responsibilities to management. May perform other duties as assigned.

Minimum Education & Experience

High School diploma and 2 years of related work experience required Associate degree preferred Or equivalent combination of education and experience

Knowledge, Skills and Abilities

• Ability to problem solve preferred
• Excellent communication skills preferred
• Ability to put information into a keyboard while typing min of 25 wpm preferred
• Strong working knowledge of the professional billing software applications preferred
• Excellent customer service skills preferred

Equal Opportunity and Diversity Statement

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture 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 characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

About the University

Learn. Discover. Heal. Create.

Located in western New York, Rochester is our namesake and our home. One of the world's leading research universities, Rochester has a long tradition of breaking boundaries - always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better. If you're looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals. At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better - Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.