University of Rochester Inpatient Transplant Billing Rep (off site location) - 227684 in Rochester, New York
Inpatient Transplant Billing Rep (off site location) Job ID 227684Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening
Full Time 40 hours Grade 009 Patient Financial ServicesSchedule
8:00 AM-4:30 PMResponsibilities
Position Summary :
Provides technical support in the daily operations through the oversight of key performance indicators for global transplant phases (pre, transplant and post). Is the key facilitator of the transplant life cycle by working these high dollar bundles as it relates to technical and professional sides of the hospital. Ensure payer contracts are adhered to. While corresponding with departments to collect and allocate global payments to the departments through Workday. Essential to have strong attention to detail, able to work independently and is a strong team player. Recognizes and supports the Strong Commitment to service excellence.
20% Support the inpatient team with Global transplant cases. Communicate effectively with designated departments (finance/contracting, professional and outpatient billing, transplant financial counselor and transplant assistance, etc.) to ensure obtaining required billing information, while maintaining time sensitive frames.
Claim submission: Ensuring all required claim and billing information is obtained to submit bundled global package.
Serve as the contact person for questions regarding transplant global bundled claim submission, collection and dispersing of funds though Workday.
Identify and monitor trends regarding delays in claim submission and payment from payers.
45% Complete follow up activities on global transplant & Medicaid/Out of State Medicaid unpaid or under/overpaid accounts by contracting payer representatives or utilizing online systems with insurance companies and other third party payers to obtain and research claim/payment status. As well as, resubmit rejected claims and verify insurance information.
Follow up on unpaid account
Check claim status using online payer’s systems or contact an insurance/provider representative to obtain information as to why payment is not received. As well as, take the necessary steps to secure claim processing/payment.
Research and calculate under or overpaid claim and determine final resolution
Re-calculate global cases based on package rates, fee schedule, APR DRG methodology and/or percent of charges.
Follow up with payer representatives on incorrectly processed and paid claims for final resolution and adjudication, including refund and credits
Review and advise manager on trends of incorrectly processed or paid claims
Work with manger on communication to payer representatives regarding trends and issues
20% Create and work weekly, bi-weekly and monthly AR reports. As well as work assigned work queues (claim edits, credits, late charges, coding changes, no response, and payment variances, etc.)
5% Support and assist the inpatient team with Medicaid/Medicaid Managed care credit balance audit.
5% Attend meetings and seminars that pertain to global transplant billing and collections.
5% Other duties as assigned.
Expectations: Participate in department staff meetings, educational classes and trainings. Stay current on HIPAA guidelines through education and reading monthly emails. Participate in URMC trainings such as, but not limited to ICARE and Annual Mandatory in Service.
Requirements: Bachelor’s degree, or an equivalent combination of education and related experience. Prefer proficiency in Excel and Word processing with Epic billing system experience. Ideally this individual will be extremely organized, a team player, effective communicator and motivated to manage time sensitive projects and assignments. In addition to the Bachelors degree that 4-5 years of experience are required.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled