Responsibilities

JOB SUMMARY:

This position is a member of a Registration and Insurance Management which coordinates functions associated with Patient demographic, guarantor, primary care physicians and insurance information for UR Medicine, MFG. FFT and HH Outpatient departments. Lead RIM Specialist requires an advance knowledge base in the rules and regulations of third party billing and the complexities of multispecialty (URMFG) etc. and Facility (SMH) billing. In addition this position requires experience among the enterprise billing system (Epic) with a proficient competency level in the use of verification, third party and government billing systems. Lead RIM Specialist will oversee the Epic work queue process of encounters with volumes in excess of 80,000 monthly for just out patient encounters; as it relates to verification of insurance which includes but is not limited to demographic, co-pay/deductibles, benefit information, referrals/authorization, PCP information and Self Pay recovery. Lead RIM Specialist is expected to function under the direction of the RIM Manager in directing the work of staff, anticipate and resolve 1st level issue or concerns, guide the decision making process and work WQ’s that are assigned to them. Ensures increase patient satisfaction, operational efficiency and effectiveness, the Lead RIM Specialist is responsible for assigning daily work. Assist with adhoc refresher training and attends operational training sessions. Set an example by demonstrating professionalism, resourcefulness and flexibility to ensure the maximum efficiency and accuracy is delivered.

KEY FUNCTIONS AND EXPECTED PERFORMANCES:

Under the direction of the RIM Manager:

TYPICAL DUTIES:

Operational Oversight Weight = 35%

• Monitor daily work queues: Responsible for assigning staff to daily work queues. Ensures RIM edits are assigned in order to maximize revenue. Maintain the verification process flow knowledge, which includes DNB/Stop bill, Charge Review and Claim Edits. Monitors that the RIM is WQ’s for same day appointments was completed prior to arrival. Report trends and frequency issues to AM WQ’s or RTE issue to Program Manager.

Daily Workload Weight = 30%

• Completed Supervisory WQ’s and assigned claim edit rules. Cover for unexpected absences.

System Support: Weight = 15%

• Epic: Participates in Epic RTE conference calls. Identify and/or Level 1 trouble shoots technical and functional issues within the Epic system as reported by staff. Well working WQ’s communicates any issues that arise.

Staff Management Weight = 20%

• Customer Interactions:, Third Party Payer resource to RIM and other staff (OAS, Insurance Collection Specialists, Financial Counselor, etc.) within UR Medicine, HH, FFT and MFG departments.

• Personnel-related matters: Acting Supervisor on site in the absence of the RIM Operational Supervisor and Manager.

• Training: Attends operational training and refresher sessions as it is identified to ensure they have an excellent understanding of workflows and procedures. Educates staff on an adhoc basis when questions or issues arise. Possess advanced knowledge in regards to insurance, Epic and Real Time Eligibility

Continuous Learning & Compliance:

• Attends and actively participates in all necessary meetings including staff meetings, etc. Timely completion of annual health update and mandatory hospital in-service. Understand and follows departmental policies and procedures relating to dress code, vacation/PTO requests and HRMS documentation.

Other:

• Provides support for Departmental activities and employee satisfaction. Exercising tact and good judgment; oversees operations in the absence of the manager. Performs other duties as assigned.

BACKGROUND EXPECTATIONS:

1. Associates degree and 3-4 years of related experience with 1 year of demonstrated leadership experience or an equivalent combination of education and experience preferably in a Primary Care Office or SMH Ambulatory setting,

2. Knowledge of Verification, Third Party Payor and Government Systems

3. Knowledge of Flowcast

4. Knowledge of PC functions (Word, Excel, e-mail, Web)

5. Requires a high degree of professionalism, motivation, interpersonal skills

6. Exercises excellent customer service and communication skills.

7. Ability to work in a team setting with all levels of management and staff

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

The University of Rochester is an Equal Opportunity Employer.

Pay Range

Pay Range: $19.37 - $27.12 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Apply for Job

• Careers

• Sign In

• New User

Location: Medical Faculty Group
Full/Part Time: Full-Time
Opening: