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University of Rochester Logo University of Rochester · Finance

Claim Resolution Representative III, Hospital/Private

United States of America, Rochester Employment contract 19.62 - 26.49 USD / Hour · Job Posted February 21, 2026
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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 Responsibility

  • Performs 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
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower-level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Researches and calculates under or overpaid claims
  • determines final resolution
  • Contacts payers on incorrectly paid claims completing resolution and adjudication
  • Adjusts accounts or processes insurance refund credits
  • Reviews and advises leadership on incorrectly paid claims from specific payers
  • Works with leadership on communication to payer representatives regarding payment trends and issues
  • Bills primary and secondary claims to insurance
  • Identifies and clarifies billing issues, payment variances, and/or trends that require management intervention
  • Assists department leadership with credit balances account reviews/resolutions and all audits
  • Coordinates response and resolution to Medicaid and Medicare credit balances
  • Requests insurance adjustments or retractions
  • Reviews and works all insurance credits in electronic health record
  • Enters electronic health record notes, documenting actions taken
  • Researches and responds to third party correspondence, receives phone calls, and explains policies and procedures involving routine and non-routine situations
  • Assists with patient related questions
  • Communicates and coordinates with other departments to resolve claim issues
  • Assists with all audits as needed

Requirements

  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
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