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University of Rochester Lead Collection Specialist (off site location) - 228647 in Rochester, New York

Lead Collection Specialist (off site location) Job ID 228647

Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening

Full Time 40 hours Grade 010 Patient Financial Services


8:00 AM-4:00 PM


Position Summary:

Provide supervisory and technical support for the Ambulatory Patient Accounts Medicaid and Fidelis team. Oversee daily billing activities and maintains control over billing and follow-up procedures for all Medicaid and Fidelis ambulatory accounts. Ensure that all billing and payments are processed per federal and state regulations. Prepare and maintain daily, weekly and monthly quality indicators for the team members, identifying goals. Serve as a liaison between department and ISD to ensure billing processes, programs and system generated reports are maintained. Assist the Outpatient Billing Manager for Medicare/Medicaid with planning and problem solving, goals and objectives for this area and by serving as a liaison between the department and other hospital departments in areas of customer service and satisfaction. Recognize and support the Strong commitment to service excellence.

Supervision and Direction Exercised:

The Lead 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.

Machines and Equipment Used:

Standard Office Equipment, including but not limited to: telephone, photocopy machine, adding machine, personal computer, fax/scanner, Microsoft Word, Excel and Email, Internet, Flowcast and Emdeon Billing Systems and a variety of payer web sites (e.g. ePaces, Fidelis).

Typical Duties:

Under general direction and with latitude for independent judgment:

25% Provide overall supervisory and technical support and direction to the Outpatient Medicaid and Fidelis team. Provide and train staff to use fee schedules and grouper tables to ensure the accuracy of account reconciliation and to ensure that accounts are billed according to timely filing requirements.

  • With support of the Medicare/Medicaid Manager administer and coordinate hospital and departmental procedures relative to charges, billing, reimbursement and accounting functions

  • Maintain knowledge of all current third party coverage, federal and state billing, reimbursement and compliance regulations and procedures

  • Review, compile and submit patient refunds and complete balance transfers

  • Ensure that requests for information from patients and external contracting agencies are responded to timely

25% Process Cancer Center accounts

  • Research claims for Cancer Center services to determine the correct billing method

  • Process billing and reconciling for all Cancer Center Medicaid accounts

  • Reconcile Fidelis Cancer Center accounts

10% Serve as a focal point for answering questions and solving problems for difficult and unusual accounts, assist in problem identification and resolution

  • Review and process monthly write offs

  • Phone/Fax Fidelis with problem claims and processing issues

  • Contact Systems Analyst when problems occur with Emdeon

15% Resolve Hold Bills for combined bills and surplus

  • Work and release the Combined Hold bills daily

  • Adjudicate OCC Surplus/Spend down hold bills accounts at least weekly

5% Prepare ambulatory team operational reports and special reports as needed to identify key indicators for A/R activities using specific criteria measuring quality, quantity and timeliness of tasks performed. Prepares and reviews with Senior Expeditor, the Expeditors and the Outpatient Account Coordinators weekly and monthly quality indicators of A/R activity in the billing area. Initiates corrective action or recommends solutions as appropriate. Prepares specific reports developed with payers in identifying accounts requiring provider intervention.

  • Prepare monthly A/R reports for both Medicaid and Fidelis

  • Copy and prepare weekly Fidelis reports for staff from Fidelis remittances

  • Track and log 277 files daily and process front end edits

  • Retrieve, record and report Medicaid weekly remittance checks for both Strong an Highland

  • Discuss accounts with coding issues with the Charge Master Analysts

  • Research resolution

  • Share resolution with staff

  • Create and maintain job aids for staff

  • Monitor and ensure that worklists are completed in a timely manner

  • Monitor payment and denial worklists

  • Monitor quality by examining a sample of visits worked by each employee during the preceding month (check account notes, check appropriate adjustments, etc)

  • Run, distribute and ensure accounts on reports are resolved properly (e.g. Medicaid credits, Unbilled reports)

5% With the support of the Outpatient Billing Manager, develop audit procedures within the Medicaid and Fidelis billing area to ensure payments from all third–party payers are based on correct rates.

  • Ensure timely processing of credit balances for government plans, other payers and patients

  • Review A/R reports generated within the billing systems to ensure accuracy and reconciliation

  • Coordinate and provide support for all internal and external billing audits, reviews or projects

5% With Outpatient Billing Manager, develop goals, objectives and operating policies and procedures for the Outpatient Medicaid and Fidelis billing team. Develop cross training programs within the payer areas for outpatient billing. Document policies and procedures.

2% Ensure a positive working environment through suggestions on team building to promote heightened team morale.

  • Provide training, coaching and reinforce billing and customer service skills to team members to ensure exceptional service

  • Empower team members by providing the appropriate level of decision making

  • Recognize and rewards team members for their contribution to the department

  • Seek feedback from other departments to improve processes and level of service within the department

  • Communicate with departments re: problem visits

3% Complete supervisory activities:

  • Complete performance evaluations for designated staff; review with Manager

  • Interview and make recommendations for new hires

  • Handle time reporting requirements in accordance with state and federal regulations.

  • Address personnel disciplinary issues

  • Ensure that staff complete the annual In Service requirements

2% Act as authority in the absence of the Outpatient Billing Manager for Medicare/Medicaid, exercising tact and good judgment.

  • Attends meetings and seminars in the absence of the Outpatient Billing Manager when appropriate

3% Other duties as assigned

  • Attend continuing education seminars offered by Medicaid and other payers

  • Represent the department on various internal and external committees

  • Complete the mandatory leadership classes offered by the Hospital

  • Attend other internal training classes as needed (Microsoft Excel training)


Participate in department/team staff meetings, educational classes and training

  • Attend monthly department and team staff meetings

  • Stay current on HIPAA guidelines through education and reading monthly emails.

  • Participate in educational training such as Strong Commitment ICare and annual In Service

  • Join PAO committees such as planning PAO events or addressing employee issues

  • Cross Train on team processes to enable assistance and fill in as needed


Bachelor’s or Associate’s Degree in Business, Health Care Administration or related discipline and 3-5 years of relevant health care experience or an equivalent combination with 1 year of demonstrated leadership experience. Working knowledge of Microsoft Word and Excel and a general knowledge of researching information via using the web.

NOTE: This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled