The University of Rochester seeks a CLM Resltion Rep III, Hosp/Prv to manage professional hospital accounts with significant latitude for initiative and independent judgment. Your primary focus will be resolving balances of aged insurance accounts not collected through routine billing and collection activities, making independent decisions on processes to collect denied claims, no-response accounts, and investigate billing issues.
What You'll Do
- Complete follow-up activities on denied, unpaid, or under-paid accounts using EPIC, payer websites, and direct contact to obtain payments and verify coverage.
- Maintain a thorough knowledge of Professional Billing policies and procedures related to insurance collection and follow-up.
- Bill primary and secondary claims to insurance.
- Identify and clarify billing issues, payment variances, and trends requiring management intervention; share findings with Supervisor and/or Manager.
- Assist Supervisor with credit balance account review/resolution and all audits.
- Research and respond to third-party correspondence and phone calls; explain policies and procedures.
- Communicate with other URMFG, HIM, Revenue Integrity, Registration and Insurance Management, PFS, EPIC Single Billing Office, and SMH departments.
- Participate in department staff meetings, education classes, and training.
- Stay current on HIPAA guidelines and participate in URMC training.
- Join PFS committees and maintain proficiency in EPIC for Insurance Follow up.
What We're Looking For
- Associate's degree in business administration.
- 2 years of hospital/professional Patient Accounting or Consumer Collections experience, OR Certification from a nationally accredited billing program (e.g., CMBS, CMRT, CMRS).
- Ability to type 25 wpm.
Technical Stack
- EPIC Billing System
- Microsoft Word, Excel, Access
- Third-party claims systems (ePaces, Connex)
- Various payer websites
Team & Environment
Follows standard procedures as directed by Supervisor or Manager. You will be responsible for self-monitoring performance and report to a Supervisor or Manager.
Benefits & Compensation
- Compensation: $19.62 - $26.49 per hour.
Work Mode
This is a hybrid position. Work locations include 905 Elmgrove Rd, Rochester, New York, 14624 and Rochester Tech Park (RTP), Gates, NY.
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 characteristic protected by law. We are defined by a deep commitment to Meliora - Ever Better, and values of equity, leadership, integrity, openness, respect, and accountability.
