University of Rochester Billing and Charge Correction Specialist in Rochester, New York

Opening

Full Time 40 hours Grade 009 Patient Financial Services

Schedule

8 AM-4:30 PM

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.

Typical Duties:

  • 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.
  • 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.
  • 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.
  • Review and complete activities related to various unbilled HAR's.
  • Monitor MUE Communication WQ’s

Qualifications:

Associate's degree in business field and 4-5 years experience in hospital billing, accounting, and/or coding; or an equivalent combination of education and experience

EOE Minorities/Females/Protected Veterans/Disabled

Job Title: Billing and Charge Correction Specialist

Location: Strong Memorial Hospital

Job ID: 209414

Regular/Temporary: Regular

Full/Part Time: Full-Time