Business Office Representative Senior

Ensure full reimbursement is received by RRH for clinical services rendered, including professional, long-term/home care, and hospital care, by effectively and accurately managing receivables. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials and payer requests for information promptly and accurately in order to secure payment. As a Senior team member, create and document new processes and support denial analyses. Work as part of a dynamic team continually looking for ways to improve a complex business process.

• →Review and accurately process claim edits in a system work queue. Accurately handle claim adjustments and coverage changes as needed.
• →Review and process claim denials according to established processes. Research and resolve denial issues via the payer website, coverage policies, and/or phone calls to the payer. Submit corrected claims and appeals. 
• →Process account adjustments and refunds as needed according to department policy and procedure. 
• →Document actions appropriately and follow up with payers to ensure they take actions promised. Follow up on claims with no responses. Manage large workload using tracking tools to ensure we don’t fail to follow up before a payer’s deadline. 
• →Help lead team meetings which review new procedures, new denial types and system updates. Report problems and patterns to the supervisor to help keep policies and procedures up to date with new clinical programs and payer policy changes. Answer staff questions about processes and problem resolution. 
• →Acquire and maintain knowledge of system terminology, claim/denial/coverage concepts and terms, and relevant HIPAA privacy rules and other regulations.  Expertly use insurance websites to explore denial issues and resolve them using the tools in Epic, including accessing clinical documentation and authorization details. 
• →Respond to patient complaints by researching coverage and claim processing to ensure the patient responsibility is accurate. Contact insurance as needed. Coordinate resolution with Customer Service staff. 
• →Create and maintain documentation of billing processes to support audits and training. Support denial trend analyses and special projects. 
• →Work directly with outside departments to assure authorizations, medical records, and appeals are accurate and timely

The posted pay range is a good faith representation of potential base pay for this position. It may be modified in the future and eligible for additional pay components. Individual annual salaries/hourly rates could vary based on position details and FTE. Pay is determined by considering factors including, but not limited to, experience, relevant qualifications, specialty, internal equity, locations, and contracts.