University of Rochester
Clm Resltion Rep III, Hosp/Prv
University of Rochester, Gates-North Gates, New York, United States
Job Posting Title Clm Resltion Rep III, Hosp/Prv
Join to apply for the
Job Posting Title Clm Resltion Rep III, Hosp/Prv
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University of Rochester Job Posting Title Clm Resltion Rep III, Hosp/Prv
4 days ago Be among the first 25 applicants Join to apply for the
Job Posting Title Clm Resltion Rep III, Hosp/Prv
role at
University of Rochester 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
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 complex claims. Acts as a resource for lower-level staff.
Job Description
ESSENTIAL FUNCTIONS
Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage. Follows up on unpaid accounts working claims. Reviews reasons for claim denial. Reviews payer website or contacts payer representatives to determine why claims are not paid. Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks. Researches and calculates under or overpaid claims; determines final resolution. Contacts payers on incorrectly paid claims completing resolution and adjudication. Adjusts accounts or processes insurance refund credits. Reviews and advises leadership on incorrectly paid claims from specific payers. Works with leadership on communication to payer representatives regarding payment trends and issues. Bills primary and secondary claims to insurance. Identifies and clarifies billing issues, payment variances, and/or trends that require management intervention. Assists department leadership with credit balances account reviews/resolutions and all audits. Coordinates response and resolution to Medicaid and Medicare credit balances. Requests insurance adjustments or retractions. Reviews and works all insurance credits in electronic health record. Enters electronic health record notes, documenting actions taken. Researches and responds to third party correspondence, receives phone calls, and explains policies and procedures involving routine and non-routine situations. Assists with patient related questions. Communicates and coordinates with other departments to resolve claim issues. Assists with all audits as needed.
Other duties as assigned.
Minimum Education & Experience
Associate's degree and 2 years of relevant experience required Or equivalent combination of education and experience
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. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
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Join to apply for the
Job Posting Title Clm Resltion Rep III, Hosp/Prv
role at
University of Rochester Job Posting Title Clm Resltion Rep III, Hosp/Prv
4 days ago Be among the first 25 applicants Join to apply for the
Job Posting Title Clm Resltion Rep III, Hosp/Prv
role at
University of Rochester 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
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 complex claims. Acts as a resource for lower-level staff.
Job Description
ESSENTIAL FUNCTIONS
Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage. Follows up on unpaid accounts working claims. Reviews reasons for claim denial. Reviews payer website or contacts payer representatives to determine why claims are not paid. Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks. Researches and calculates under or overpaid claims; determines final resolution. Contacts payers on incorrectly paid claims completing resolution and adjudication. Adjusts accounts or processes insurance refund credits. Reviews and advises leadership on incorrectly paid claims from specific payers. Works with leadership on communication to payer representatives regarding payment trends and issues. Bills primary and secondary claims to insurance. Identifies and clarifies billing issues, payment variances, and/or trends that require management intervention. Assists department leadership with credit balances account reviews/resolutions and all audits. Coordinates response and resolution to Medicaid and Medicare credit balances. Requests insurance adjustments or retractions. Reviews and works all insurance credits in electronic health record. Enters electronic health record notes, documenting actions taken. Researches and responds to third party correspondence, receives phone calls, and explains policies and procedures involving routine and non-routine situations. Assists with patient related questions. Communicates and coordinates with other departments to resolve claim issues. Assists with all audits as needed.
Other duties as assigned.
Minimum Education & Experience
Associate's degree and 2 years of relevant experience required Or equivalent combination of education and experience
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. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Other Industries Higher Education Referrals increase your chances of interviewing at University of Rochester by 2x Get notified about new Job Posting Title Clm Resltion Rep III, Hosp/Prv jobs in
Gates, NY . Rochester, NY $129,000.00-$206,000.00 2 weeks ago Customer Service Representative - State Farm Agent Team Member
Rochester, NY $62,500.00-$85,000.00 1 year ago Rochester, NY $115,000.00-$184,000.00 3 days ago Rochester, NY $60,000.00-$70,000.00 18 hours ago Customer Relations Representative - State Farm Agent Team Member
Webster, NY $50,000.00-$70,000.00 2 months ago Customer Service Representative (CSR) - Durable Medical Equipment (DME)
Rochester, NY $35,000.00-$45,000.00 4 weeks ago Palmyra, NY $38,900.00-$63,300.00 3 weeks ago Business Development Account Manager - Performance Media
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Customer Service Representative - State Farm Agent Team Member
Brockport, NY $35,000.00-$42,000.00 2 years ago Customer Service Representative - State Farm Agent Team Member
Webster, NY $40,000.00-$50,000.00 2 years ago Customer Service Representative - State Farm Agent Team Member
Victor, NY $37,000.00-$60,000.00 2 years ago Rochester, NY $50,000.00-$80,000.00 1 month ago Future Opening: Customer Service Representative - State Farm Agent Team Member
Parkinson's Account Executive - Buffalo, NY
Rochester, NY $51,498.15-$85,830.25 5 days ago Rochester, NY $80,000.00-$85,000.00 2 weeks ago Assistant Wholesale Sales Operations Manager
Rochester, NY $100,000.00-$100,000.00 4 days ago Client Service Representative / Boarding
Strategic Account Executive - Laboratory Diagnostic Sales
Rochester, NY $87,600.00-$125,000.00 1 day ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr