Claims Resolution Representative II Job at University of Rochester (Rochester)

Claims resolution representative II

The claims resolution representative II is responsible for working across the pr...

Location

United States of America , Rochester - NY; Albany

Salary:

18.71 - 25.27 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

High School Diploma and 2 years of related work experience or equivalent combination of education and/or experience
Strong working knowledge of the professional billing software applications
Excellent customer service skills

Job Responsibility

Performing routine follow-up activities designed to bring all open account receivables to successful closure
Effective claims follow-up to obtain maximum revenue collection
Researching, correcting, resubmitting claims, submitting appeals and taking timely and routine action to resolve unpaid claims
Follows department policies and procedures and maintains and exercises thorough knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivables
Follows up on denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission
Research claims, identifies problems, and takes appropriate action to assure claim resolution
Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing
Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims
Follows established procedure for missing insurance payment information on claims

Fulltime

Claim Resolution Representative II

As a community, the University of Rochester is defined by a deep commitment to M...

Location

United States of America , Rochester

Salary:

18.71 - 25.27 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

High School diploma
2 years of related work experience
Or equivalent combination of education and experience

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 moderately complex claims
Edits and reviews In-Patient and Out-Patient accounts to ensure completion, accuracy, and reflect the particular patient's financial responsibility
Exercises tact and judgment, interviews patients and/or responsible parties
May establish financial arrangements for charges
Processes commercial insurance claims when applicable
Refers to collectors for payment arrangements, if appropriate
Retains responsibility for patient bills until paid in full

Fulltime

Patient Self-Pay Resolution Center Representative II

The Patient Financial Representative performs the functions of Patient Account M...

Location

United States of America , Rochester

Salary:

19.08 - 25.77 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

High school graduate with 4 years of experience in healthcare, billing, or collections experience
Bachelor's degree with at least 1 year of related experience
Equivalent combination of education and experience
Proven and effective diplomatic communicator demonstrated by the ability to consistently present and express oral and written information in an organized, understandable, complete, and concise manner
Ability to remain professional and focused under multiple pressures and demands
Strong organizational skills, reasoning, and problem solving skills
Ability to multi-task in order to efficiently resolve customer concerns, by actively listening to the customer, navigating multiple programs and applications at the same time, typing call documentation, and speaking to the customer simultaneously
Ability to prioritize tasks and work in fast paced environment
Ability to work effectively as a member of a team
Actively participate in and contribute to the daily operations of the Patient Services Department by identifying improvements to processes, services, and the patient experience

Job Responsibility

Responds to patients' inquiries via telephone, MyChart, mail, email, and fax, concerning, but not limited to, billing issues, claim payments, contract benefits, and medical billing in accordance with HIPAA, Third Party Billing rules and regulations, and the Fair Credit Debt Collection Practices Act
Acts as a liaison among the customers, business partners, and plans in a professional, self-directed manner to ensure and promote customer satisfaction and retention
Provides timely responses to customer inquiries by telephone, email or website chatbox in an in- or outbound service center, consistent with service and quality standards
Troubleshoots and resolves customer complaints
Researches, interprets and responds to inquiries from internal and external customers concerning unresolved patient billing issues, outstanding balances as a result of statements sent within the billing systems (EPIC, Flowcast, and HBOC) utilizing reference materials and available resources
Resolves customer inquiries in an accurate, organized, efficient, timely, and expert manner
Consistently adheres to all Patient Service policies, procedures, and performance measures including inquiry documentation procedures
Maintains performance and quality standards based on established call center metrics including turn-around times
Initiates insurance billing either electronically or via the use of the Electronic Work file transfer process within the billing systems for accounts classified as Self-Pay in error
Identifies and verifies coverage under the government health insurance programs

Fulltime

Patient Self-Pay Resolution Center Representative II

The Patient Financial Representative acts with compassion and empathy, exercises...

Location

United States of America , Rochester

Salary:

19.08 - 25.77 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

High school graduate with 4 years of experience in healthcare, billing, or collections experience
Bachelor's degree with at least 1 year of related experience
Equivalent combination of education and experience

Job Responsibility

Provides timely responses to customer inquiries by telephone, email or website chatbox in an in- or outbound service center, consistent with service and quality standards
Troubleshoots and resolves customer complaints
Performs the functions of Patient Account Management for individuals receiving care from the University of Rochester Medical Center (URMC), Highland Hospital (HH), and University of Rochester Medical Facility Group (URMFG)
Responds to patients' inquiries via telephone, MyChart, mail, email, and fax, concerning, but not limited to, billing issues, claim payments, contract benefits, and medical billing in accordance with HIPAA, Third Party Billing rules and regulations, and the Fair Credit Debt Collection Practices Act
Acts as a liaison among the customers, business partners, and plans in a professional, self-directed manner to ensure and promote customer satisfaction and retention
Researches, interprets and responds to inquiries from internal and external customers concerning unresolved patient billing issues, outstanding balances as a result of statements sent within the billing systems (EPIC, Flowcast, and HBOC) utilizing reference materials and available resources
Resolves customer inquiries in an accurate, organized, efficient, timely, and expert manner
Consistently adheres to all Patient Service policies, procedures, and performance measures including inquiry documentation procedures
Maintains performance and quality standards based on established call center metrics including turn-around times
Initiates insurance billing either electronically or via the use of the Electronic Work file transfer process within the billing systems for accounts classified as Self-Pay in error

Fulltime

Claims Resolution Specialist II

Baptist Health is hiring a Claims Resolution Specialist II for our Physician Bil...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

High School Diploma/GED
1-2 years Revenue Cycle Operations Experience Required
Less than 1 year Billing Experience Required
Less than 1 year Medical Insurance Experience Required
Less than 1 year Reimbursement Experience Required
Less than 1 year Accounts Receivable Experience Required
Less than 1 year Knowledge of CPT, ICD10, HCPCS and Modifiers Required

Job Responsibility

Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers
Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities
Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims
Follows-up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims
Works all assigned accounts on worklist in order depending on balance and age
Identify and communicate trends in denials to leadership
Requires experience in either HB or PB while working toward competency in all areas of the assigned vertical
Communicates with various departments to resolve any outstanding issues with claim to resolve denials
Possesses up to date knowledge related to CPT codes, ICD/10 codes

Fulltime

Billing & Collections Representative II

Under the direction of the Manager Professional Billing & Coding, the Billing & ...

Location

United States , San Diego

Salary:

Not provided

Rady Children's Hospital-San Diego

Expiration Date

Until further notice

Requirements

H.S. Diploma,GED,or Equivalent
2 Years of Experience
Must possess some medical billing experience

Job Responsibility

Resolution of all outstanding balances from all payors, including Commercial, Medi-Cal and Managed Care professional claims
Checking status of unpaid claims by telephone, websites and/or any other means available
Providing all necessary documentation required from payors to ensure accurate adjudication of claim for reimbursement
Processing claims correctly following contractual arrangements the Medical Practice Foundation (MPF) has with each Payor
Accurately analyzing each denial received by reviewing the patient acct, the remittance codes from Explanation of Benefits (EOB) and Remittance Advice (RA)
Reviewing CCI or payor specific coding edits and taking necessary steps to send a corrected claim or appeal to payor for reprocessing of claim to overturn denial
Reporting all problematic payor trends to leadership with specific examples
Daily processing of assigned work queues following standards established by Leadership
Reviewing payor/clearing house rejections and making necessary corrections to ensure claim will be adjudicated
Following federal, state, and local regulatory collection guidelines as well as department and payor specific billing guidelines

What we offer

Medical, Dental, Vision, Life, Pet insurance
Retirement Plan
Tuition Assistance
Wellness program

Fulltime

Billing & Collections Representative II

Under the direction of the Manager Professional Billing & Coding, the Billing & ...

Location

United States , San Diego

Salary:

23.10 - 31.77 USD / Hour

Rady Children's Hospital-San Diego

Expiration Date

Until further notice

Requirements

H.S. Diploma,GED,or Equivalent
2 Years of Experience
Must possess some medical billing experience.
A certificate of completion from a medical billing course can be substituted for 1 year of experience

Job Responsibility

Resolution of all outstanding balances from all payors
Checking status of unpaid claims by telephone, websites and/or any other means available
Provide all necessary documentation required from payors to ensure accurate adjudication of claim for reimbursement
Process claims correctly following contractual arrangements
Accurately analyze each denial received by reviewing the patient acct, the remittance codes from Explanation of Benefits (EOB) and Remittance Advice (RA)
Review CCI or payor specific coding edits and take necessary steps to send a corrected claim or appeal
Report all problematic payor trends to leadership
Daily processing of assigned work queues
Review payor/clearing house rejections and making necessary corrections
Follow federal, state, and local regulatory collection guidelines as well as department and payor specific billing guidelines

What we offer

Medical, Dental, Vision, Life, Pet insurance
Retirement Plan
Tuition Assistance
Wellness program

Fulltime

Technical Service Representative II

At Percepta, we bring first-class service across each market we support. As a Te...

Location

United States , Melbourne

Salary:

Not provided

TTEC

Expiration Date

Until further notice

Requirements

High School Diploma or equivalent
Minimum 2-3 year of customer service experience
Minimum 1-year recent experience as an automotive technician in a powertrain or body/chassis/electrical diagnostic and repair role or equivalent training - preferred
Ability to analyze repair shop diagnosis information to determine coverage eligibility
Ability to read and understand workshop manual and electrical schematics
Ability to speak confidently about repair procedures
Proficiency with part numbers and parts catalog supersession pertaining to powertrain assemblies
Excellent interpersonal skills
Ability to use conflict resolution and negotiation skills to resolve difficult contacts from an automotive technical perspective
Strong working knowledge of the Internet, computers, and software (MS Office products, Internet Explorer, etc.)

Job Responsibility

Receive inbound calls from competitive make dealerships and independent repair facilities regarding powertrain warranty claims adjudication per contract terms and contact handling processes
Receive inbound calls from F/L dealerships, competitive make dealerships, independent repair facilities, and vehicle owners regarding warranty process/policy and claims adjudication per contract terms and contact handling processes
Receive inbound calls from independent inspectors taking verbal inspections reports and documenting them in the appropriate systems
Receive inbound emails from 3rd party vendors and process warranty claims for Motor craft products
Review digital photographs and supporting documentation
Provide real time powertrain related technical assistance to competitive make dealerships and independent repair facilities
Perform detailed claim analysis and adjudication per contract terms and contact handling processes
Place outbound calls to independent repair facilities and dealerships providing claim approval/denial details
Communicate with dealers and repair facilities in a professional, knowledgeable, empathetic manner pertaining to claim adjudication and concerns if authorization will not be provided
Provide assistance to F/L dealerships inquiring about the national powertrain network (NPN)

What we offer

Culture of Service
Teamwork
Respect
Proactive
CareerGrowth
Diversity
Competitive Compensation
programs that offer incentives and promote physical, mental, and financial wellness

Select Country

Claims Resolution Representative II

Job Description

Job Responsibility

Requirements

Looking for more opportunities?

Claims Resolution Representative II

Claims resolution representative II

Claim Resolution Representative II

Patient Self-Pay Resolution Center Representative II

Patient Self-Pay Resolution Center Representative II

Claims Resolution Specialist II

Billing & Collections Representative II

Billing & Collections Representative II

Technical Service Representative II

Our AI answers in your language