Clm Resltion Rep IV, Hosp/Prv

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, 14624Opening:Worker Subtype:RegularTime Type:Full timeScheduled Weekly Hours:40Department:500011 Patient Financial ServicesWork Shift:UR - Day (United States of America)Range:UR URC 206 HCompensation Range:$21.40 - $28.89The 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: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.ESSENTIAL FUNCTIONSIndependently 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. Identifies and resolves problems related to primary and secondary accounts which are disputed, unpaid, underpaid or overpaid. Determines cause of problem and initiatives corrective action through reviews of electronic medical records. Works to confer with external agencies. Analyzes accounts and determines if correct proration of revenue has been collected, using detailed understanding and application of all payer contracts. Contacts applicable agency, payer or department for resolution. Decides when resubmitting efforts are complete, including writing an appeal using applicable content and supporting documentation to appropriately influence the highest level of revenue.Acts as a resource for questions from assigned collection and billing staff on payer policies, procedures and methods of revenue collection. Trains new staff on the use of the billing application, payer systems, and clearinghouse systems. Demonstrates how to apply the knowledge of payer contracts and resources to resolve disputed, unpaid, underpaid, or overpaid accounts. Provides feedback to leadership on results of training of new and existing staff. Provides input for performance assessments based on observation, questions, and quality reviews of work performed. Acts as area leader, when needed, including responding to payers, pa...