Medical Claims Follow-up Specialist

Rochester, NY

Responsibilities

Job Summary

The Physician Billing specialist is responsible for resolving unpaid or rejected insurance accounts which have not been collected through routine billing. The Physician Billing specialist will follow up with the payers determining the best collection technique, resulting in payment or resolution of the outstanding claim. This role will efficiently and effectively use EPIC and will adhere to documented policies and procedures related to billing guidelines.

Key Functions and Expected Performances

With general direction of the Manager and with latitude for initiative and judgment:

20% Maintains and exercises thorough knowledge of third party billing requirements and insurance regulations to review and follow up on unpaid insurance claims bringing about prompt payment of all outstanding receivables.

20% Initiates task completion in EPIC by review of the invoice and determine invoice resolution by phone calls, correction of a claim – rebilling, investigation of medical documentation, addition of a modifier, claims appeal, etc. Prioritizes account work efficiently and effectively.

20% Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing prior to charge entry. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims.

20% Follows up on ‘non-routine’ denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Researches claims, identifies problems and takes appropriate action to assure claim resolution.

10% Mails paper claims with appropriate attachments when needed (insurance EOB, medical records, etc.). Processes Medicaid claims thru ePaces. Ensures additional documentation and/or information is provided for claims processed thru iHCFA, Claim Logic, CBAS, ePaces, etc. ensuring claims are billed without error.

5% Prepares reports for management to document recurring problems and identifies the source of reimbursement delays. Works closely with management to ensure effective communication to resolve invoice payment delays.

5% Completes special projects as assigned.

Qualifications:

  • Required:
  1. Associates degree and 2 years of professional medical claims billing and collecting experience.

OR

Certification obtained from a nationally accredited billing program, i.e.: CMBS (Certified Medical Billing Specialist).

  • Preferred:
  1. Experience working with the EPIC system.

  2. Strong knowledge of physician/professional fee billing or consumer collections experience; or an equivalent combination of education and experience.

  3. Third party billing guidelines and knowledge. Excellent interpersonal and communication skills. Good organizational skill.

  4. Experience working with automated billing systems and knowledge of Microsoft Word, Microsoft Excel.

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

Pay Range

Pay Range: $ 17.50 - $ 23.08 Hourly

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.

Location: Medical Faculty Group
Full/Part Time: Full-Time
Opening: Full Time 40 hours Grade 008
Schedule: 8 AM-4:30 PM