Clm Resltion Rep IV, Hosp / Prv

Job Title

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

Opening : 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 206 H

Compensation Range : $20.99 - $28.34

Responsibilities : 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.

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 :

• Independently determines the most effective method to follow up on disputed, unpaid, underpaid, or overpaid insurance or contracted service accounts in order to bring about prompt account resolution and revenue collection from complex claims, high dollar claims, and specialized services.
• 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.
• Other duties as assigned.

Minimum Education & 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.