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Claims 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:

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Contract Type:
Not provided

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Salary:

19.62 - 26.49 USD / Hour

Job Description:

The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management.

Job Responsibility:

  • Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
  • Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
  • Research claims, identify problems, and take 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
  • Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies
  • Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding
  • Escalates system issues preventing claims submission and follow-up for review and resolution
  • Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate

Requirements:

  • Associate degree and 2 years of related relevant experience
  • or equivalent combination of education and/or experience
  • Excellent problem-solving skills
  • Excellent communication skills
  • Excellent customer service skills

Nice to have:

  • Strong working knowledge of the professional billing software applications
  • Ability to type 25 wpm

Additional Information:

Job Posted:
February 21, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
Job Link Share:

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