Claim Resolution Representative III Job at University of Rochester (Rochester)

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

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Claim Resolution Representative III

Job Description

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Claim Resolution Representative III

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