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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 Location (Full Address):

905 Elmgrove Rd, Rochester, New York, United States of America, 14624

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500011 Patient Financial Services

Work Shift:

UR - Day (United States of America)

Range:

UR URC 205 H

Compensation Range:

$19.62 - $26.49

_The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._

Responsibilities:

GENERAL PURPOSE

With latitude for initiative and independent judgment within department guidelines, the position is responsible for managing inpatient/outpatient accounts from the beginning of the billing period through the accurate resolution of the account. Revenue collection activities focus on an assigned payer billed at the primary level. Activities performed will focus on resolving balances on aged insurance accounts which have not been collected through routine billing and collection activities, ensuring the visit balances are set up on the accounts receivable at expected reimbursement, and determining and completing the collection process that will result in payment. Makes independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Maintain a detailed knowledge of billing requirements and regulations to ensure that the process conforms to federal and state regulations. The Claim Resolution Rep III will represent the department and Strong Memorial Hospital (SMH) in a professional manner, protecting confidentiality of patient information at all times.

Location

Rochester Tech Park (RTP), Gates, NY - Remote options available after in-person training. Occasional onsite meetings / work at RTP are required. Remote location must be within 2 hours of RTP and within New York State.

ESSENTIAL FUNCTIONS

Supervision and Direction Exercised** **:

The Claim Resolution Rep III is responsible for self-monitoring performance on assigned tasks, following standard procedures and as directed by the Supervisor, Revenue Cycle Management.

Machines and Equipment Used** **:

Standard office equipment, including but not limited to telephone, photocopy machine, adding machine, personal computer (for claims inquiry and entry software) fax/scanner, Flowcast billing application, Microsoft Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro) and various payer web sites.

Typical Duties** **:

30% Complete follow up activities on unpaid or under-paid accounts by contacting payer representatives or utilizing online systems with insurance companies and other third-party payers to obtain payments, research and resubmit rejected claims to primary payers, obtain and verify insurance information.

+ Follow up on unpaid accounts

+ For unpaid accounts, check claim status on appropriate payer system or contact an insurance representative to obtain information as to why claims are not paid and steps necessary for processing/payment

+ Initiate collection phone calls to insurance companies to determine reason for claim denial or reason for unpaid claim.

+ Address unpaid claims and solicit a payment date from the payer.

+ Research and calculate under or overpaid claims; determine final resolution

+ Re-calculate claim based on fee schedule, APC or APG grouper, appropriate % of charge, or ASC payment methodology, including add-ons

+ Follow-up with payers on incorrectly paid claims through final resolution and adjudication, including refund of credits

+ Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers

+ Work with supervisor/manager on communication to payer representatives regarding payment trends and issues

25%Work weekly, bi-weekly and monthly reports and Work Lists via calculating and processing transactions such as payer-to-payer transfers, contractual adjustments, verify that the insurance levels and proration are set up correctly on the system.

+ Examples of reports:

+ 2nd level report

+ Medicare and Medicaid credit balance report

+ Over $10 k report

+ Claim edits

+ 20 % Utilize a thorough knowledge of inpatient/outpatient billing policies and procedures for primary levels of third-party insurance; prepare log and related management reports when needed, price claims to establish the expected reimbursement on the revenue cycle system.

+ Initiate payer-related accounts receivable report to determine which visits needs special attention and follow up to obtain correct full reimbursement

+ Billing primary and secondary claims to insurance

+ Review paper claims prior to billing. Review includes potential of high cost, and late charges to facilitate any necessary manual keying into ancillary billing systems (ePaces, Emdeon, Omnipro, etc).

20% Identify and clarify issues, payment variances and/or trends that require management intervention; share with Supervisor and or Manager. Assist Supervisor with Medicare and Medicaid credit balance audits, and third-party payor audits

+ Coordinate responses and resolution to Medicaid and Medicare credit balances

+ Review all accounts on the Medicaid and Medicare credit balance report:

+ Request insurance adjustments or retractions

+ Prepare requests for insurance and patient refunds

+ Enter Flowcast visit note documenting status or action taken.

+ Coordinate with other department within SMH to get claim issues resolved and complete audits.

Expectations:

+ Participate in department staff meetings, education classes and training

+ Stay current on HIPAA guidelines through education and reading monthly emails

+ Participate in URMC training such as Strong Commitment, ICare and Annual Mandatory In-Service

+ Join PFS committees such as Planning PFS events or addressing employee issues

Qualifications:

+ Requires: Associate's degree in business administration and 2 years of hospital patient accounting or consumer collections experience; or an equivalent combination of education and experience.

Note: This document describes typical duties and responsibilities and is not intended to limit managers from assigning other work as required.

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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Learn. Discover. Heal. Create.

Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.

If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals

At the University of Rochester, we are committed to fostering, cultivating, and preserving an inclusive and welcoming culture and are united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.