Description
Purpose:
Design, develop, and analyze system edits, payer and provider system maintenance, electronic submission errors and financial/statistical reports that will support the operational needs of the central business office. Provide weekly/monthly summaries to the management team.
Responsibilities:
- Perform duties and job responsibilities in a manner which promotes the core values of UPMC (Quality and Safety, Dignity and Respect, Caring and Listening, Excellence and Innovation, Responsibility and Integrity) in all consumer and UPMC interactions.
- Attend all mandatory training as defined in UPMC and Revenue Cycle Policies and Procedures manuals.
- Refran from disclosing or revealing confidential information to any person and do not access patient or coworker records (either electronic or files) except as specifically necessary to perform job duties.
- Liaise with physician offices, internal departments and insurance companies to develop accurate estimate if requests are vague or incomplete.
- Deliver Price Estimates to patients in a courteous and knowledgeable manner, providing clarification about the patient's benefits if requested.
- Mantain compliance with quality standards.
- Utilize the price estimate software where applicable.
- Maintain departmental productivity levels.
- Create timely Price Estimates by identifying and analyzing comparable patient examples, utilizing insurance website or hotlines to confirm eligibility and benefits, reviewing appropriate fee schedules to determine correct charges and applying all information to ascertain patient liability.
Qualifications
- High School diploma or equivalent and 5 years of experience, OR Bachelor's degree and 1 year of experience.
- Bachelor's degree in Business Administration, Finance or Accounting preferred.
- Strong PC and computer skills are required (Excel, Access and Crystal report writing).
- Must possess strong analytical and problem-solving skills.
- Familiarity with large-scale, automated patient billing systems (e.g., Medipac, EPIC), medical terminology, and fee schedules and coding (e.g., CPT/HCPCS) preferred.
- Strong analytical and problem solving skills, organization and time management.
- Previous experience with insurance verification and benefit application preferred.
- Must develop and manage positive working relationships with colleagues, management, 3rd party payers, patients or their representatives, physicians and hospital leadership.
- Good oral and written communication skills required.
Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days
- Act 33 with renewal
- Act 34 with renewal
- Act 73 FBI Clearance with renewal
UPMC is an Equal Opportunity Employer/Disability/Veteran
COVID-19 Vaccination Information
Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.
Total Rewards
More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.
Our Values
At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.