Business Office Representative

Job Title: Business Office Representative

Department: Financial Services

Location: Riedman Campus - 100 Kings Highway, Rochester, NY 14610

Hours Per Week: 40

Schedule: M-F; 7:00 AM to 3:30 PM or 8:00 AM to 4:30 PM

Summary:

Ensure full reimbursement is received by RRH for clinical services rendered including professional, long-term/home care and hospital care, by effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly and accurately in order to secure payment. Work as part of a dynamic team continually looking for ways to improve a complex business process.

Key Responsibilities:

• Review and accurately process claim edits in a system work queue. Accurately handle claim adjustments and coverage changes as needed.
• Review and process claim denials according to established processes. Research and resolve denial issues via the payer website, coverage policies and/or phone calls to the payer. Submit corrected claims and appeals.
• Process account adjustments and refunds as needed according to department policy and procedure.
• Document actions appropriately and follow-up with payers to ensure they take actions promised. Follow-up on claims with no responses. Manage large workload using tracking tools to ensure we don’t fail to follow-up before a payer’s deadline.
• Participate in team meetings which review new procedures, new denial types and system updates. Report problems and patterns to the supervisor to help keep policies and procedures up to date with new clinical programs and payer policy changes.
• Acquire and maintain knowledge of system terminology, claim/denial/coverage concepts and terms, and relevant HIPAA privacy rules and other regulations. Expertly use insurance websites to explore denial issues and resolve them using the tools in Epic, including accessing clinical documentation and authorization details.
• Respond to patient complaints by researching coverage and claim processing to ensure the patient responsibility is accurate. Contact insurance as needed. Coordinate resolution with Customer Service staff.

Desired Attributes:

• Education/Training: At least one year experience in a Medical Office environment preferred
• Basic knowledge of medical billing, cording, collection processes, insurance policies and governmental regulation provision preferred
• Knowledge of UBO4 billing form and 1500F05 specific payer requirements preferred
• Excellent problem solving, organizational and oral and written communication skills required
• Successful completion of annual age and job specific competencies and skill verification tools required
• Proficiency in a variety of computer applications and spreadsheet applications and common office equipment

PHYSICAL REQUIREMENTS: Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

PAY RANGE: $18.50 - $22.25