- 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
- 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 (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