CrawlJobs Logo

Claim Resolution Representative III, Hospital/Private

urmc.rochester.edu Logo

University of Rochester

Location Icon

Location:
United States of America , Albany

Category Icon
Category:

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

19.62 - 26.49 USD / Hour

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

Additional Information:

Job Posted:
February 21, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Claim Resolution Representative III, Hospital/Private

New

Claim Resolution Representative III, Hospital/Private

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
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
  • Fulltime
Read More
Arrow Right
New

Pharmacy Technician

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States , Palmyra
Salary
Salary:
16.50 - 25.00 USD / Hour
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
April 03, 2026
Flip Icon
Requirements
Requirements
  • Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
  • If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
  • If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
  • Regular and predictable attendance, including nights and weekends
  • Ability to complete required training within designated timeframe
  • Attention and Focus: Ability to concentrate on a task over a period of time
  • Ability to pivot quickly from one task to another to meet patient and business needs
  • Ability to confirm prescription information and label accuracy, ensuring patient safety
  • Customer Service and Team Orientation: Actively look for ways to help people, and do so in a friendly manner
  • Notice and understand patients’ reactions, and respond appropriately
Job Responsibility
Job Responsibility
  • Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
  • Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
  • Contributing to positive patient experiences by showing empathy and genuine care: creating heartfelt and personalized moments while serving patients at pick-up, drive-thru, and over the phone
  • keeping patients healthy by offering immunizations and other services at the register and over the phone
  • and demonstrating compassionate care by solving or escalating patient problems
  • Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team, such as accurately putting away medication deliveries and completing cycle counts, returns-to-stocks, waiting bin inventories, etc.
  • Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
  • actively seeking opportunities to expand clinical and technical knowledge needed to better assist patients
  • Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
  • voluntarily traveling to stores in the market to work shifts as needed by the business
What we offer
What we offer
  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
  • Parttime
Read More
Arrow Right
New

Server

Servers lead the Guest Experience at the table and ensure our Guests have everyt...
Location
Location
Canada , Banff
Salary
Salary:
Not provided
bostonpizza.com Logo
Boston Pizza
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Leads by example and works alongside their team members
  • Achieves goals through strong organizational skills and effective time management
  • Builds relationships by finding common ground and working cohesively with all team members
  • Committed to championing the "Foundations of Hospitality," Boston Pizza's Brand Standards and Food Safety
  • Effectively communicates, sharing goals and challenges
  • Maintains composure and thrives in a fast pace environment
  • They practice the responsible selling and serving of alcohol at all times, handle payments and anticipate the Guest expectations by offering on-going and upcoming promotions and utilizing bar and food knowledge
  • Driven by professional development opportunities, and is consistently seeking new learning and skill-building moments
Job Responsibility
Job Responsibility
  • Servers lead the Guest Experience at the table and ensure our Guests have everything they need from appetizers to desserts
  • Masters of situational service, they tailor their style to meet the needs of our Guests
  • Servers are responsible for the accuracy of the entire order as well as maintaining a positive and Guest focused attitude through the entire experience
  • They demonstrate and believe in championing a fun and safe work environment and contribute to a thriving workplace culture
What we offer
What we offer
  • Flexible scheduling that fits your lifestyle and contributes to your life-work balance
  • Exciting opportunities for career growth within the restaurant or at Boston Pizza head office
  • Build relationships and give back to your local community
  • Boston Pizza Scholarship Program
  • Management Training Programs, Leadership Development conferences and access to dynamic mentorship programs and initiatives
  • A respectful culture and work environment where your feedback matters
  • Fantastic reward and recognition programs
Read More
Arrow Right
New

RN, Home Care Liaison

The Acute Care Coordinator role is to serve as an adjunct to the multidisciplina...
Location
Location
United States of America , Rochester
Salary
Salary:
36.73 - 47.75 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate of Applied Science in Nursing
  • Minimum of 5 years of professional nursing experience
  • Registered RN in New York State (preferred)
  • Computer skills, familiarity with electronic medical record
Job Responsibility
Job Responsibility
  • Identifies patient discharge needs
  • Assists in implementing patient care strategies to close gaps in medical care upon discharge
  • Leads daily discharge rounds
  • Identifies resources for patient self-management planning and discharge
  • Assists in developing and implementing care plan for medically complex patients
  • Prepares patient for discharge by ordering home nursing services/IV medications/tube feedings and DME
  • Other duties as assigned
  • Parttime
Read More
Arrow Right
New

HGV Driver Class 2

You’ll be responsible for safely and professionally transporting stock (mainly p...
Location
Location
United Kingdom , Lewes
Salary
Salary:
Not provided
bssindustrial.co.uk Logo
BSS
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Class 2 driving licence with up-to-date CPC records
  • Have held a Category B license for 12+ months
  • Confidence in building new relationships and maintaining strong customer connections
  • A safety-focused approach
  • Passion for delivering excellent service and meeting customer needs
  • A strong team mentality with a shared drive for success and ambition
Job Responsibility
Job Responsibility
  • Safely and professionally transporting stock (mainly pipeline and heating products) from branches to customers
  • Multi-drop deliveries with regular returns to the branch to reload for the next run
What we offer
What we offer
  • Bonus potential YOU control—£300 per quarter for safe driving
  • Annual branch bonus
  • Modern fleet
  • ALLMI lorry-mounted crane (HIAB) training fully funded
  • 20% off Toolstation and tool hire at Travis Perkins
  • Access to hundreds of discounts—food, holidays, dining out, cinema, retail, and more
  • 22 days of holiday per year, plus 8 Bank Holidays
  • Yearly pay reviews
  • Share Schemes: Buy shares in our business at a discounted rate via salary deduction
  • Company pension plan
  • Fulltime
Read More
Arrow Right
New

Sales Assistant

Part time role working 28 hours a week in one of our busy furniture stores. Our ...
Location
Location
United Kingdom , Halifax
Salary
Salary:
12.21 GBP / Hour
bhf.org.uk Logo
British Heart Foundation
Expiration Date
March 05, 2026
Flip Icon
Requirements
Requirements
  • Passion, energy, and ability to deliver the very best customer service
  • Confident within a team environment and comfortable guiding the activity of volunteers
  • Able to work well under pressure and on your own initiative in a dynamic and fast-paced environment
  • Attention to detail
  • Positive, creative, confident, customer service focussed and passionate about sustainability
  • Comfortable with tech, able to use a Till, PC, Smartphone and e-mail with ease
  • Must be 18+ years old
  • Flexibility to work weekends and bank holidays on a rota basis
Job Responsibility
Job Responsibility
  • Engage with customers, providing exceptional service and promoting our charity’s mission
  • Organise and merchandise donated stock creatively to maximise sales potential
  • Collaborate with our E-Commerce team to maximise online sales
  • As a Keyholder, be the go-to person when there isn’t a manager on duty, keeping the store running and ensuring our customers have a great experience
  • Work on the till
  • Sort donations
  • Lift large pieces of furniture
What we offer
What we offer
  • 38 days annual leave (plus the option sell leave)
  • Holistic support leave of up to 10 additional days off each year
  • Enhanced family policies (maternity, paternity and adoption leave)
  • Wagestream - early access to your wages
  • 25% staff discount
  • Health cash plan (Dental, Optical, Therapies, etc)
  • Access to a 24/7 Virtual GP and Employee Assistance Programme (EAP)
  • Pension with employer contribution of up to 10%
  • Cycle to work scheme
  • Discounts on gym memberships
  • Parttime
Read More
Arrow Right
New

Assistant General Manager

Assistant General Managers at Canada's leading casual dining restaurant, Boston ...
Location
Location
Canada , Fredericton
Salary
Salary:
Not provided
bostonpizza.com Logo
Boston Pizza
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Skilled at overseeing food preparation, ordering supplies, scheduling shifts, and monitoring inventory levels
  • demonstrate outstanding leadership
  • have a strong foodservice background
  • communicate effectively
  • champion a fun and safe working environment
  • leads by example and works alongside their team members
  • achieves goals through strong organizational skills and effective time management
  • builds relationships by finding common ground and working cohesively with all team members
  • committed to championing the 'Foundations of Hospitality,' Boston Pizza's Brand Standards and Food Safety
  • effectively communicates, sharing goals, challenges and is continuously coaching the team on ways to progress
Job Responsibility
Job Responsibility
  • Oversee the daily Heart of House operations
  • ensure guests and Heart of House team members have an excellent Boston Pizza experience
  • oversee food preparation, ordering supplies, scheduling shifts, and monitoring inventory levels
  • oversee the daily operations of the Restaurant
  • includes the training, development, staffing, scheduling and performance management of the Front of House team members
What we offer
What we offer
  • Training & Professional Development: Online and on the job training, Manager Development Certification and Management Training Program, Leadership conference and leadership on the road
  • Work/Life Balance: Flex scheduling, days or nights
  • Industry Leader: 55 year old company with over 375 Restaurants from coast to coast
  • Community Focused: A company entrenched in community service with opportunities to give back
  • Collaboration: Share your best ideas with our corporate team – KM Corner, KM Council, Access to Regional Operations Managers, Senior Operations Managers and Senior Leadership
  • Awards & Recognition: BPI Scholarship Awards
  • Flexible scheduling that fits your lifestyle and contributes to your life-work balance
  • Exciting opportunities for career growth within the restaurant or at Boston Pizza head office
  • Build relationships and give back to your local community
  • Boston Pizza Scholarship Program
  • Fulltime
Read More
Arrow Right
New

Talent Acquisition Partner

Airwallex is scaling our key corporate functions globally, and we’re looking for...
Location
Location
Germany , Berlin
Salary
Salary:
Not provided
Airwallex
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 7+ years of full-cycle recruiting
  • 2+ years in-house recruiting experience
  • Deep expertise in go-to-market and corporate hiring
  • Proven track record hiring top talent across Sales, Legal, Risk, Compliance, Finance, Operations, Strategy, and Marketing, from entry to Director levels
  • Skilled at partnering with and influencing senior business leaders
  • Thrives in fast-paced, scaling environments
  • Creative, resourceful, and passionate about building high-performing teams
Job Responsibility
Job Responsibility
  • Partner with executives to define hiring needs and shape talent strategies
  • Design and execute innovative sourcing strategies to engage exceptional corporate talent
  • Lead the full hiring process, from outreach to offer
  • Use recruiting metrics and market insights to influence decisions and improve efficiency
  • Ensure interviewer calibration and promote best practices
  • Manage recruitment across multiple European markets
  • Fulltime
Read More
Arrow Right