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University of Rochester Logo University of Rochester · Finance

Claim Resolution Representative IV, Hospital/Provider

United States of America, Rochester 20.99 - 28.34 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 and obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Mentors and trains new or lower level staff
  • Independently determines the most effective method to follow up on disputed, unpaid, underpaid, or overpaid insurance or contracted service accounts
  • Identifies and resolves problems related to primary and secondary accounts which are disputed, unpaid, underpaid or overpaid
  • Acts as a resource for questions from assigned collection and billing staff on payer policies, procedures and methods of revenue collection
  • Trains new staff on the use of the billing application, payer systems, and clearinghouse systems
  • Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts and status of collection activities
  • Resolves accounts identified in third party audits involving retroactive approvals, resulting in adjustments, refunds, and subsequent secondary billing
  • Identifies need for in-person meetings and phone conferences with third party insurance representatives
  • Identifies and clarifies issues that require management and intervention to avoid loss of revenue
  • Researches and initiates suggestions to leadership to streamline processes and training materials
  • Performs coverage for other positions as needed
  • Performs administrative office tasks and maintains records
  • Other duties as assigned

Requirements

  • Associate's degree and 3 years of relevant experience required
  • Or equivalent combination of education and experience
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