What are the responsibilities and job description for the Business Office Representative position at Rochester Regional Health Careers?
Job Title: Business Office Representative
Department: Patient Accounting, Anesthesiology
Location: Riedman Campus, 100 Kings Highway, Rochester NY 14617
Hours Per Week: 40
Schedule: Full-Time, Day Shift (7 am -4:30 pm), Monday to Friday
SUMMARY:
Ensure full reimbursement is received by RRH for clinical services rendered including professional, long-term/home care and hospital care, by effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly and accurately in order to secure payment. Work as part of a dynamic team continually looking for ways to improve a complex business process.
RESPONSIBILITIES:
Review and accurately process claim edits in a system work queue. Accurately handle claim adjustments and coverage changes as needed.
Review and process claim denials according to established processes. Research and resolve denial issues via the payer website, coverage policies and/or phone calls to the payer. Submit corrected claims and appeals.
Process account adjustments and refunds as needed according to department policy and procedure.
Document actions appropriately and follow-up with payers to ensure they take actions promised. Follow-up on claims with no responses. Manage large workload using tracking tools to ensure we don’t fail to follow-up before a payer’s deadline.
Participate in team meetings which review new procedures, new denial types and system updates. Report problems and patterns to the supervisor to help keep policies and procedures up to date with new clinical programs and payer policy changes.
Acquire and maintain knowledge of system terminology, claim/denial/coverage concepts and terms, and relevant HIPAA privacy rules and other regulations. Expertly use insurance websites to explore denial issues and resolve them using the tools in Epic, including accessing clinical documentation and authorization details.
Respond to patient complaints by researching coverage and claim processing to ensure the patient responsibility is accurate. Contact insurance as needed. Coordinate resolution with Customer Service staff.
REQUIRED QUALIFICATIONS:
Excellent problem solving, organizational and oral and written communication skills
Successful completion of annual age and job specific competencies and skill verification tools required
Proficiency in a variety of computer applications and spreadsheet applications and common office equipment
PREFERRED QUALIFICATIONS:
Education/Training: At least one year experience in a Medical Office environment
Basic knowledge of medical billing, cording, collection processes, insurance policies and governmental regulation provision
Knowledge of UBO4 billing form and 1500F05 specific payer requirements
PHYSICAL REQUIREMENTS: S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
PAY RANGE: $18.50 - $23.03
Salary : $19 - $23