[Hiring] Senior Account Representative @UPMC

Role Description

The Account Representative, Senior is responsible for all fiscal functions necessary to ensure the prompt and correct payment to the hospital of all monies owed by both insurers and patients. Responsibilities include:

• Ensure claims are submitted accurately and timely.
• Communicate with insurance companies, patients, and physicians regarding payment issues.
• Establish reasonable payment arrangements.
• Recommend adjustments according to UPMC policies.
• Review the posting and balancing of payment/denial and adjustment transactions necessary for closing accounts.
• Identify and assign appropriate status codes.
• Review high dollar accounts on a regular basis.
• Identify recurring problems and procedural deficiencies that need to be reported to management.
• Serve as a key mentor to staff for training and procedural direction.

Qualifications

• Must have 1 year of claims/billing/collections experience; OR 4 years in a business office setting; OR a Bachelor's Degree; OR an equivalent combination of education and experience.
• Excellent interpersonal, organizational, communication, and effective problem-solving skills are necessary.
• Must be able to communicate with patients, payers, outside agencies, and the general public through telephone, electronic, and written correspondence.
• Prior working experience on personal computers, electronic calculators, and office equipment is needed.
• Must be multi-disciplined in billing, collections, denials, credit balances, and/or the various payers.
• Prior collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.
• Familiarity with third-party payer guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
• This position requires organization and time management skills.
• The incumbent must develop and manage relationships with colleagues in a professional, independent manner.
• The position requires the ability to maintain confidentiality with regard to all assignments.

Requirements

• Ability to work multiple payers.
• Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies.
• Identify root cause issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials.
• Assist in claim appeal process and/or perform follow-up in accordance with Revenue Cycle policies and procedures.
• Manage assigned book of business by ensuring the timeliness and accuracy of billing, collections, contractual postings, payments, and adjustments of accounts based upon their functional area standards.
• Evaluate and recommend referrals to agency, law firm, Financial Assistance, and Bad Debt.
• Understand third-party billing and collection guidelines.
• Demonstrate knowledge of the current functionality of the patient accounting systems.
• Identify issues and submit corrective action recommendations.
• Ability to work independently with minimal supervision.
• Meet quality assurance benchmark standards and maintain productivity levels as defined by management.

Licensure, Certifications, and Clearances

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran.