Revenue Cycle Coordinator IV - Remote/Hybrid Opportunity

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, 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.

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