Responsibilities

Position Summary :

Provides billing and charging support to Patient Financial Services, Revenue Integrity, Medical Faculty Group, and hospital departments consistent with enterprise-wide billing models. Ensures that charges are processed per models as well as payer policies and regulations regarding placement of modifiers.

Supervision and Direction Exercised :

The Billing and Charge Correction 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 the Operations Supervisor and Assistant Director, PFS.

Typical Duties :

Under general direction and with latitude for independent judgment:

35%

For hospital billing:

• Review Coverage Manager II work queues. Review payer coverage changes made at the patient guarantor level, the timing of the change and the impact to charges.

• Determine department and billing model of impacted charges and determine appropriate action.

• Perform appropriate billing action (update insurance on HAR if appropriate, ensure that all charges impacted have been rerouted properly, verifying correct dollar amount charged) to create compliant and billable claims for service.

For professional billing:

• Verify that rerouted charges have posted properly in PB.

• Work with hospital PBB manager, URMFG/departmental staff and Revenue Integrity to resolve charge split issues based on billing models.

30%

• Using enterprise-wide billing models:

• Receive reports requiring charge corrections.

• Determine root cause of error.

• Perform appropriate billing action (update insurance on HAR if appropriate, ensure that all charges impacted have been rerouted properly, verifying correct dollar amount charged) to create compliant and billable claims for service.

• Work with hospital PBB manager, URMFG/departmental staff and Revenue Integrity to resolve charge split issues based on billing models.

20%

• In a highly independent environment, provide advanced and proficient billing and follow-up activities to the Patient Financial Services department for Dialysis billing.

• Assume total responsibility for monitoring contracted payments and notification and follow-up to outside agencies when payments are outside of contractual obligations.

• Provide timely and accurate information regarding this action to Finance to assure future business or contracts are not negatively impacted.

• With support of the Outpatient Billing Manager, administer and coordinate hospital and departmental procedures relative to charges, billing, reimbursement, and accounting functions associated with Dialysis billing.

• Maintain knowledge of all current contracts and changes in reimbursement, federal and state billing, and compliance regulations and procedures.

• Complete collection activities to collect both low and high dollar accounts.

• Identify and resolve problems related to those accounts, including but not limited to duplicate or incorrect charges, incorrect coding, erroneous contract information and initiate corrected claim submission accordingly.

• Create and submit appeals for denials.

• Communicate with internal departments for authorization and coding issues.

• Document all actions and interact with ancillary areas to secure needed assistance.

10%

• Review and complete activities related to various unbilled HAR’s.

• Monitor MUE Communication WQ’s.

5%

• Other duties as assigned

Expectations :

Attends internal and external meetings and seminars when appropriate; attends continuing education seminars as needed.

Qualifications:

Bachelor’s Degree preferred, or Associates Degree and 4 years of relevant health care experience; or an equivalent combination of education and experience.

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: $21.71 - $29.31 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.

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Location: Strong Memorial Hospital
Full/Part Time: Full-Time
Opening:
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