- University of Rochester (Rochester, NY)
- …expertise of the individual, and internal equity considerations._ **Responsibilities:** The Claims Resolution Representative II is responsible for ... open account receivables to successful closure. Responsible for an effective claims follow-up to obtain maximum revenue collection. Responsibilities include but are… more
- CRST (Amherst, NY)
- …quality and review documentation + Communicate with CRST staff about the status of claims and reaching their resolution + Attend regular scheduled meetings with ... analysis, and processing of-and reporting on-insurance and self-insurance programs and claims . Risk management personnel manage the company's risk by analyzing and… more
- Independent Health (Buffalo, NY)
- …and paid time off (PTO), including company paid holidays. The Customer Service Representative position offers an opportunity to begin a career at Independent Health. ... the department and our family of companies. **Overview** The Customer Service Representative (CSR) is responsible for displaying confidence, passion for service, and… more
- Molina Healthcare (Rochester, NY)
- …highest level of customer service. Effectiveness in driving timely issue resolution , EMR connectivity, Provider Portal Adoption. * Resolves complex provider issues ... monthly site visit goals. A key responsibility of the Representative during these visits is to proactively engage with...3 - 5 years customer service, provider service, or claims experience in a managed care setting. * 3+… more
- Rochester Regional Health (Rochester, NY)
- …effectively and accurately managing a receivable. Resolve edits to ensure accurate claims are sent to primary and secondary insurances. Research and resolve denials ... payer website, coverage policies and/or phone calls to the payer. Submit corrected claims and appeals. + Process account adjustments and refunds as needed according… more
- Molina Healthcare (Rochester, NY)
- …methods. + Analyzes and assist with complex eligibility issues and provides resolution to internal partners and external clients. and regulators (CMS, Medicaid ... party administrators. + Performs enrollment functions to include call tracking, claims workflow, and encounter requests for verification and updates, PCP assignment… more
- University of Rochester (Rochester, NY)
- …unpaid accounts, check claim status on appropriate payer systems or contact an insurance representative to obtain information as to why claims are not paid and ... from the payer. - - - Research and calculate underpaid or overpaid claims ; determine final resolution .- - - Re-calculate claim based on fee schedule, APC or APG… more
- University of Rochester (Rochester, NY)
- …unpaid accounts, check claim status on appropriate payer systems or contact an insurance representative to obtain information as to why claims are not paid and ... date from the payer. + Research and calculate underpaid or overpaid claims ; determine final resolution .- - - Re-calculate claim based on fee schedule, APC or APG… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …new product lines, and working closely with Operations, Customer Care, Claims , and Finance/Underwriting departments to support group implementations and address ... between group administrators and internal departments to facilitate problem resolution . Essential Accountabilities: Level I + Researches, interprets, and responds… more
- University of Rochester (Rochester, NY)
- …accounts from the beginning of the billing period through the accurate resolution of the account. Collection activities will focus on self pay accounts. ... that the process conforms to federal and state regulations. The Collections Representative will represent the department and Strong Memorial Hospital (SMH), Highland… more
- Excellus BlueCross BlueShield (Rochester, NY)
- Job Description: Summary: This position is the primary representative for Physician, Ancillary and Facility reimbursement analysis. The incumbent's analyses include ... implementing rate adjustments and enhancements as necessary. * Research and manage resolution of provider payment inquiries, disputes and issues. * Participate and… more
- NFTA (Buffalo, NY)
- …new departmental guidelines, policies and procedures. Ability to apply judgment to settle claims . Ability to negotiate the resolution of controversies and the ... The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. It is not necessarily… more
- Independent Health (Buffalo, NY)
- …and up-to-date information on policies and procedures and communicate a successful resolution to inquiries. + Ensure compliance with all DOL rules and regulations. ... standards in the following categories as measured and recorded in the representative 's scorecard. + Log all contacts into appropriate systems. + Technical… more