Billing Specialist/Financial Coordinator
Using considerable judgement and knowledge of billing and reimbursement processes the Transplant Billing Specialist is responsible for the management of the solid organ transplant liver & kidney charge review process in EPIC for all transplant recipients and donors registered within URMC, approximately 3000 patients on average. Serve as a contact for HB and PB billing corrections and act as a subject matter expert on transplant billing processes. This position also includes extraction and compilation of daily laboratory data from outside laboratories.
Organ Acquisition Claims Management and Work Queues
Uses critical thinking skills and knowledge of transplant evaluation processes to review hospital and provider charges in EPIC (12 HB and 3 PB) work queues. Determine, by medical record review if claims belong in organ acquisition or should be submitted to the patient insurance company.
Seeks advice and guidance from clinical team if claims are unclear. May need to request provider note modification from clinical team if visit/procedure/test is documented incorrectly.
Prioritizes work queues efficiently and effectively based on the designated workflow
Process 312 requisitions for payment to URMC departments for appropriate charges relating to transplant and covered by MCR cost reporting after adjusting charges to appropriate Medicare rate.
Combine Highland’s charges from monthly report with Highland’s client bill. Reduce HB charges to MCR rate and request payment for Highland’s charges using electronic system (P2P)
Keep records of all payments to Highland and URMC.
Billing Issue Resolution and Optimization
Utilizes A/R experience and knowledge of billing software system, third party payer requirement and insurance regulation to resolve complex accounts in specialty billing
Researches and make suggestions to optimize key performance in the resolution of Pre-A/R and Accounts Receivable.
Review and correct monthly report generated for errors on donor and recipient charges.
Maintain up to date knowledge of MCR cost guidelines and payment rates in order to facilitate billing issue resolution.
Data Retrieval and outside labs
Receive and sort daily laboratory results sent by fax and mail from outside laboratories (40+ labs in the nine-county Finger Lakes Region). Contact outside facilities by telephone to obtain results not received.
Record laboratory values in eRecord (and OTTR) for daily review by clinical team. Hold lab results until complete, retrieve pending results.
Access Lab system interfaces (such as Quest, ACM) on the internet for patient results.
Administration Quest Quantum
Outside Claim Review
Reviews claims from outside providers and lab corporations to determine if they should be reimbursed by organ acquisition account or patient insurance and pushes them through the system to the appropriate payer.
Recognize trends within various areas of specialize billing and bring forth suggestions/solutions to the problem working with other teams and/or the department when necessary.
Using appropriate tools and calculations reduces claims for outside providers to Medicare rates.
Request payment for all approved External claims using electronic system (P2P).
Send detailed letter with reason for rejection on all external claim denials.
Keep records of all payments and denials to outside facilities.
- Enter appropriate organ charges into Epic for all completed transplants.
Associate’s degree or 3 years’ experience working in a healthcare office setting or other billing and collection experience in Medical, Secretarial or related field preferred
Three years of relevant experience preferred
Technical: The ability to type, operate standard office equipment including computer, calculator, telephone, facsimile, computer skills on Microsoft Office Suite (Word, Excel, Office, PowerPoint) required.
Specialized Systems: Working knowledge of the professional billing software applications and EPIC preferred.
Strong analytic skills and the ability to problem solve independently. Attention to detail and excellent organization skills required.
Team player: Experience working in a team setting is preferred. This position requires a high level of interaction with many different team members including other pre-transplant specialists, nurses, APPs, physicians, surgeons, social workers, nutritionists, pharmacists, financial counselors and administrators required. Must be comfortable raising concerns and speaking up in team meetings.
Medical Terminology, experience with surgical/appointment scheduling software (such as Flowcast) and electronic medical records preferred.
Interpersonal Skills: Demonstrated customer relations skills, strong interpersonal and communication skills, including written communication required.
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.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled
Location: Strong Memorial Hospital
Full/Part Time: Full-Time
Opening: Full Time 40 hours Grade 009 Solid Organ Transplant SMH