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Claim Resolution Representative III

urmc.rochester.edu Logo

University of Rochester

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Location:
United States of America , Rochester

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Category:
Finance

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Contract Type:
Not provided

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Salary:

19.62 - 26.49 USD / Hour
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Job Description:

With latitude for initiative and independent judgment within department guidelines, the position is responsible for managing professional hospital accounts. Activities performed will focus on resolving balances of aged insurance accounts which have not been collected through routine billing and collection activities.

Job Responsibility:

  • Managing professional hospital accounts
  • Resolving balances of aged insurance accounts
  • Making independent decisions as to the processes necessary to collect denied insurance claims, no response accounts, and investigating resolving billing issues
  • Maintaining a detailed knowledge of billing requirements and regulations
  • Representing the department and Strong Memorial Hospital (SMH) in a professional manner, protecting confidentiality of patient information
  • Completes follow up activities on denied, unpaid, or under-paid accounts
  • Maintains a thorough knowledge of Professional Billing
  • Identify and clarify billing issues, payment variances and/or trends that require management intervention
  • Research and respond to third party correspondence, receive phone calls, explain policies and procedures
  • Participate in department staff meetings, education classes and training
  • Stay current on HIPAA guidelines
  • Participate in URMC training
  • Join PFS committees
  • Maintains proficiency in EPIC for Insurance Follow up

Requirements:

  • Associate's degree in business administration required
  • 2 years of hospital/professional Patient Accounting, Consumer Collections experience, or Certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS) required
  • Or an equivalent combination of education and experience
  • Ability to type 25 wpm Required

Additional Information:

Job Posted:
February 20, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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