Clm Resltion Rep IV, Hosp/Prv

Rochester, NY


Job Summary

The Specialty A/R associate will handle all functions associated with the resolution of an exclusive set of complex accounts. The tasks in specialty billing will be workflow driven and the associate will be expected to research, retain and make suggestions to optimize key performance in collections in this area.

Resolves system edits; unpaid and denied insurance/client accounts, resulting in payment or resolution of the outstanding claim. The Specialty A/R associate will utilize MFG and/or payer billing software and will adhere to documented policies, procedures and workflows related to billing and collection.

Key Functions and Expected Performances

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

40% Utilizes A/R experience and knowledge of billing software system, third party payer requirement and insurance regulation to resolve complex accounts in specialty billing. Researches and makes suggestions to optimize key performance in the resolution of Pre-A/R and Accounts Receivable. Prioritizes work queues efficiently and effectively based on the designated workflow.

30% Researches claims, identify problems and take appropriate action to assure claim resolution. Recognize trends within various areas of specialized billing and bring forth suggestions/solutions to the problem working with other teams and/or the department when necessary.

10% Follows up on ‘non-routine’ denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic claims submission, etc. Communicates with insurance representatives through telephone calls, payer website, and in written communication Mails paper claims with appropriate attachments when needed (insurance EOB, medical records, etc.). Ensures additional documentation and/or information is provided for claims.

10% 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% Verifies correct patient demographic information, guarantor account and completes insurance pre-verification utilizing payer website. The Specialty AR associate will communicate any missing/incomplete information to their manager to if a charge is lacking any information to be sent out correctly.

5% Completes special projects as assigned.


  • Required:
  1. Associates Degree and 4-5 years of professional medical claims billing and collecting experience; or equivalent combination of education and/or experience

  2. Demonstrated organizational and problem-solving skills

  3. Effective written and verbal communication skills

  • Preferred:
  1. Strong working knowledge of the professional billing software applications

  2. Strong analytical skills

  3. Knowledge of Microsoft Office programs (Word, Excel etc.)

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: $20.57 - $27.78 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: Medical Faculty Group
Full/Part Time: Full-Time