Revenue Cycle Coordinator IV - Remote/Hybrid Opportunity

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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 URCA 206 H

Compensation Range

$21.71 - $29.31

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

G the position is responsible for managing both aged inpatient and outpatient accounts from the time that they have passed a certain aging threshold through the accurate resolution of the account. This position will also be responsible for the follow up and collection of accounts that are complex based on high dollar amounts, multiple payers, unique billing and/or payment arrangements, and specialized services. Revenue Collection activities focus on an assigned payer billed at the primary level. Activities performed will focus on resolving balances on aged insurance accounts which have not been collected through routine billing and collection activities, ensuring the visit balances on the accounts receivable are at expected reimbursement based on contractual agreements with payers, and determining and completing the collection process that will result in payment. Makes independent decisions as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues that affect reimbursement of claims and advising the management team of those trends and propose resolution.

Typical Duties

Complete follow up activities on unpaid or under-paid accounts including complex high dollar and specialized accounts by contacting payer representatives or utilizing online systems with insurance companies and other third-party payers to obtain payments, research, and resubmit rejected claims to primary payers, obtain and verify insurance information.

• Follow up on unpaid accounts- - - For unpaid accounts, check claim status on appropriate payer systems or contact an insurance representative to obtain information as to why claims are not paid and steps necessary for processing/payment.
• Initiate collection phone calls to insurance companies to determine reason for claim denial or reason for unpaid claim. Address unpaid claims, and solicit a payment date from the payer.
• Research and calculate underpaid or overpaid claims; determine final resolution.- - - Re-calculate claim based on fee schedule, APC or APG grouper, appropriate % of charge, or ASC payment methodology, including add-ons
• Follow up with payers on incorrectly paid claims through final resolution and adjudication, including refund of credits
• Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers
• Work with supervisor/manager on communication to payer representatives regarding payment trends and issues
  

Work weekly, bi-weekly, and monthly reports and work lists via calculating and processing transactions such as payer to payer transfers, contractual adjustments, verify that the insurance levels and proration are set up correctly in the system.

• Identify and clarify issues that requirement management intervention to avoid loss of revenue.
• Recommends the filing of a formal complaint with the State's regulation commission or agency.
• Determines when to change the account to a self-pay financial class after a review of previous efforts has not resulted in revenue collection and further attempts would not be successful without patient intervention.
• 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 accounts.
• Prepares information for and attend meetings with third party insurance representatives on claims and system issues for scheduled in-person meetings and phone conferences regarding complex accounts.
  
  

Utilize a thorough knowledge of inpatient/outpatient billing policies and procedures for primary levels of third-party insurance; prepare log and related management reports when needed, price claims to establish the expected reimbursement in the revenue cycle system.

• Initiate payer-related accounts receivable report to determine which visits needs special attention and follow up to obtain correct full reimbursement
• Review paper claims prior to billing. Review include potential of high cost, and late charges to facilitate any necessary manual keying into ancillary billing systems (ePaces, Emdeon, OmniPro, etc.)
  
  

Identify and clarify issues, payment variances and/or trends that requirement management intervention; assist management team with Medicare and Medicaid credit balance audits, and third-party payer audits.

• Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and Medicare credit balance report
• Request insurance adjustments or retractions
• Prepare requests for insurance and patient refunds
• Enter notes into billing system documenting status or action taken
  

Research and respond to third party correspondence, receive phone calls, explain policies and procedures involving routine and non-routine situations. Assist other areas with patient related questions. Communicate with other hospital departments and with government and commercial insurance companies. Any additional duties as assigned.

• Coordinate with other departments within the Hospital to get claim issues resolved and complete audits.
• Research and initiate suggestions to management to streamline processes and training materials
  
  

Qualifications

Associates degree in Business Administration and 4-5 years of hospital patient accounting or consumer collections experience; or an equivalent combination of education and experience or certification obtained from a nationally accredited billing program.

EOE Minorities / Females / Protected Veterans / Disabled

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion 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 status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

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Located in western New York, Rochester is our namesake and our home. One of the world’s leading research universities, Rochester has a long tradition of breaking boundaries—always pushing and questioning, learning and unlearning. We transform ideas into enterprises that create value and make the world ever better.

If you’re looking for a career in higher education or health care, the University of Rochester may offer the perfect opportunity for your background and goals

At the University of Rochester, we commit to diversity, equity, and inclusion and united by a strong commitment to be ever better—Meliora. It is an ideal that informs our shared mission to ensure all members of our community feel safe, respected, included, and valued.