University of Rochester Insurance Collection Spec in Rochester, New York
Full Time 40 hours Grade 008 URMFG Business Office
8 AM-4:30 PM
The Insurance Collection Specialist is responsible for resolving unpaid or rejected insurance accounts which have not been collected through routine billing. Insurance Collector will follow up with the payers determining the best collection technique, resulting in payment or resolution of the outstanding claim. The Insurance Collection Specialist will efficiently and effectively use EPIC and Enterprise Task Manager (ETM) and will adhere to documented policies and procedures related to billing and collection.
With general direction of the Practice Operations Management Team and with latitude for initiative and judgment:
Maintains and exercises thorough knowledge of third party billing requirements and insurance regulations to review and follow up on unpaid insurance claims bringing about prompt payment of all outstanding receivables. Initiates task completion in EPIC and Enterprise Task Manager (ETM) by review of the invoice and determine invoice resolution by phone calls, correction of a claim - rebilling, investigation of medical documentation, addition of a modifier, claims appeal, etc. Prioritizes account work efficiently and effectively.
Verifies correct patient demographic information and completes insurance pre-verification utilizing payer website before entering charges into Flowcast. Billing staff will communicate any missing/incomplete information to providers and department administrative support staff to ensure accurate billing prior to charge entry.
Follow-up on 'non-routine' denied accounts through review of remittances (EOBs), insurance-correspondence, rejections received thru daily-electronic claims submission, etc. Able to researches claims, identify problems and take appropriate action to assure claim resolution. 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.). Processes Medicaid claims thru ePaces. Ensures additional documentation and/or information is provided for claims processed thru iHCFA, Claim Logic, CBAS, ePaces, etc. ensuring claims are billed without error.
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.
Completes special projects as assigned.
- Associates degree and 2 years of hospital patient accounting or consumer collections experience or certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience.
- Requires strong knowledge of physician/professional fee billing and third party billing. Excellent interpersonal and communication skills. Good organizational skill.
- Experience working with automated billing systems and knowledge of Microsoft Word, Microsoft Excel.
- Experience working with the EPIC system.
- Experience working with the GE Flowcast system.
- Experience in Enterprise Task Manager Workflow.
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Insurance Collection Spec
Location: Medical Faculty Group
Job ID: 209450
Full/Part Time: Full-Time