Claims Resolution Representative 4

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):

156 West Ave, Brockport, New York, United States of America, 14420

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500054 SMH Hem/Onc - Strong West

Work Shift:

UR - Day (United States of America)

Range:

UR URC 206 H

Compensation Range:

$20.99 - $28.34

Responsibilities:

Wilmot Cancer Institute is looking for an experienced, compassionate, and detail-oriented Insurance Biller - Bone Marrow Transplant to join our growing team. The ideal candidate will have a comprehensive understanding of insurance billing procedures, a commitment to providing excellent patient care, and a strong attention to detail. The successful candidate will need to demonstrate a commitment to excellence and have the ability to collaborate with a diverse team. If you are looking for an exciting opportunity to make a difference in the lives of cancer patients, this is the position for you!

The ideal candidate has experience in transplant programs including contracting, provider relations, or transplant billing and collections. We are willing to train the right candidate if you have lack experience but in a different area such as medical contracting, provider relations, or billing/collections.

Utilizing prior coding and billing experience the staff member is responsible for collecting, posting and managing patient Bone Marrow Transplant accounts. Submission of claims must be done in accordance with all regulatory factors. The staff member is expected to have a detailed knowledge of insurance regulations, billing procedures and available resources in order to complete their daily work. This staff member will also be expected to have a strong attention to detail, possess excellent customer service skills, be able to interact with a variety of personality types and conduct themselves in accordance with the ICARE values.

ESSENTIAL FUNCTIONS

Customer Interactions:  15%

• Acts as billing and collections resource, providing factual information to both internal and external customers. Maintains a thorough understanding of the University delegated payers and their billing, coding and collection requirements. Has an understanding of other payers and knows how to obtain information regarding those plans. Answers questions regarding billing statements, EOBs and any patient balances that may arise, resolving billing questions and correcting accounts as appropriate. Thorough attempt is made to resolve any billing disputes. Assists physicians with finance questions.

​National Marrow Donor Program:  30%

• Completing National Marrow Donor Billing Resolves unpaid insurance accounts which have not been paid/rejected within a predetermined period and are impeding the prompt resolution of A/R.  Contacts are via correspondence, telephone or meeting with insurance representatives. If unable to resolve insurance problem with third-party insurance for any reason (lack of cooperation, etc.):  Advises supervisor who has option of filing a formal complaint with state regulating commission and changes the account to a self-pay financial class, advising patient and responsible collection specialist.

Work Queue Management and Reporting:  25%

• Responsible for resolving Work Queues in EPIC including, but not limited to Transplant work queues router review WQ’s 7405, 7406 and 7407: Follow Up; Claim Edit; Charge Review (Audit and Review); Missing Guarantor. Research and analyze denials, correct errors to ensure charges captures and processed and goal for site errors is met or exceeded. Resolve work queue & denials through research and analysis by reviewing chart and office notes, pre-authorizations, hospital documentation, etc. Ensure charges drop for claims processing.
• Routinely works hospital reports to ensure that claims are being sent in a timely, efficient manner. Resolves accounts within timely filing guidelines. Compiles aging reports and other reports as necessary to meet requirements and maintains records for effective reporting on both daily and weekly basis. Prepares accounts for referral to collection agencies if determined uncollectible through University collection efforts. Researches, corrects and/or re-bill accounts needing attention. Documents all actions for both patient and University personnel and interact with ancillary areas to secure needed assistance/documentation to meet insurers’ requirements. Receives billing inquiries from patients and other entities such as NMDP, Pathology labs, etc. Discusses and global billing or transplant-related claims with patients and involves them in the resolution of their balances.

Billing:  25%

• Edits follow up bills originated by EPIC, contacting payers and resolving any questions of why the original claim was not paid. Responsible for communicating with insurance companies, other payer, and patients, to ensure patient accounts are current and complete. If unable to resolve insurance problem with third-party insurance for any reason (lack of cooperation, etc); Identifies and contributes to resolution, collaborates with internal payer contracting department and/or files appeal and advises supervisor who has option of filing a formal complaint with state regulating commission and changes the account to a self-pay financial class, advising patient and responsible collection specialist. Obtains medical records and other required documentation to assure timely payment of the account. Checks to ensure all primary and secondary insurance are effective and in priority order to ensure proper billing. Ensures open communication with appropriate entities regarding transplant account changes. Verifies that all account adjustments meet department/hospital guidelines

Training:  5%

• Trains all claims resolution specialists that join the WCI Business office. Assists in completion of staff evaluations for employees. Maintains and utilizes knowledge of bone marrow transplant contractual agreements and government regulations by reviewing all information as received and by attendance at informational meetings as scheduled. Provides education to financial staff regarding any changes in process, procedures and regulations and ensures team members are also aware.

SUPERVISED BY:  Associate Director/ Wilmot Billing Administrator

• Performance on assigned tasks is monitored against departmental standards.  May train and coordinate activities of peers or other staff as assigned by management.  May work in a self-directed team.

MINIMUM EDUCATION & EXPERIENCE

• 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.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to type 25 wpm.
• Experience working with transplant programs including, but not limited to transplant contracting, transplant provider relations, transplant billing and collections, etc.
• Must be able to multi-task and pivot across duties as needed.

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.