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Claim Resolution Representative IV

University of Rochester

Location:
United States of America , Rochester

Category:
Finance

Contract Type:
Not provided

Salary:

20.99 - 28.34 USD / Hour

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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
Researches and responds to clinical department inquiries on complex, high dollar, and specialized accounts and status of collection activities affecting departmental revenue
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 due to claim and system issues requiring prompt attention for complex high dollar accounts
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

Requirements:

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

Additional Information:

Job Posted:
February 20, 2026

Employment Type:

Fulltime

Work Type:

Hybrid work

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