University of Rochester Insurance Collection Spec in Rochester, New York


Full Time 40 hours Grade 008 Primary Care Billing Services


Job Summary:

The Primary Care Billing Service (PCBS) Insurance Collection Specialist is responsible for resolving unpaid or rejected insurance accounts which are not collected through routine billing and follow up and to determine collection technique, resulting in probable payment. The Insurance Collection Specialist is responsible for self - monitoring performance on assigned tasks, following standard procedures and may train and coordinate activities of peers and lower level staff, as directed by Associate Director, Manager or Lead Insurance Specialist.

  • Communicates clearly with all levels of employees and other customers.
  • Regularly interacts with Primary Care Network Offices, Third Party Payers, URMC Systems Departments, PCBS Leads and Management.
  • Promotes cooperation within the department and leads by example, works as a team player to improve office function.
  • Possesses advanced computer skills including GE Flowcast, Microsoft office, electronic mail, Internet and Intranet, payer web-based software and electronic medical records.
  • Completes work accurately, in a timely manner with great attention to detail.
  • Documents all actions and outcomes within billing system invoices, PCS comments and/or financial comments fields to support actions taken and ensure availability of information.

Essential Functions:

*Collections: *

  • Exercising thorough knowledge of third party billing and coding requirements, HIPAA rejection codes and GE Flowcast programming; determines the most effective method of follow up on unpaid insurance accounts to bring about prompt account resolution and collection of accounts receivable.
  • Responsible for follow up of denied insurance accounts by way of the GE Flowcast Paperless Collection System utilizing multiple payer web-based products and Electronic Medical Records system, prioritizing order of accounts to work efficiently and effectively.
  • Identifies and resolves problems related to insurance accounts, including but not limited to duplicate or incorrect charges, incorrect coding, erroneous registration, incorrect payer processing and initiates corrections accordingly.
  • Follows up on non-routine denied accounts received by way of correspondence, electronic payer edits, GE Flowcast system edits and patient communications, researches and identifies resolution and resolves accounts receivable through corrections of accounts and/or correct resubmissions to payers.

*Credit Resolution: *

  • Exercising thorough knowledge of coordination of benefits (COB) requirements set by third party payers, identify appropriate primary / secondary payers to correct GE Flowcast registrations, accounts in a credit balances and prevent future COB issues.
  • Reconcile accounts to identify incorrect patient and/or third party payer payments, research and obtain backup of recorded payments to submit payer adjustments, request payer take-backs, obtain refund checks and/or initiate patient refunds.

*Problem Resolution: *

  • Identifies patterns of denied and/or unpaid claims, researching area of issue, recommending changes to billing system programming, educating network office staff and/or presenting information to management for intervention with third party payers.
  • Completes special projects as assigned by Management.

Education: Associate's degree in the medical field and two years (prefer three years) experience in physician billing setting;or certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience.

Experience: Experience working with automated billing systems and/or GE Flowcast preferred.

Technical: Microsoft Office including: Microsoft Word and Excel and electronic scheduling. Advanced written and verbal communication skills.

EOE Minorities/Females/Protected Veterans/Disabled

Job Title: Insurance Collection Spec

Location: Strong Memorial Hospital

Job ID: 208595

Regular/Temporary: Regular

Full/Part Time: Full-Time