Description

UPMC Rx Partners is looking for a full time Payment Specialist II to join their dedicated team!

Analyze, post, balance and report payments and denials for designated entities and payers to the appropriate billing system(s). Manage electronic remittance file retrieval and posting, and various control processes (imaging, spreadsheet updating, account monitoring, etc).

This role will work 9 am to 5:00 pm or 9:30 am to 6:30 pm, and one weekend rotation every 5 weeks.

UPMC offers a generous benefits package, an expansive total rewards package, opportunity to grow your career and much more. Apply today!

Responsibilities:

• Expanded knowledge of PLB processes by payer. Includes the aptitude to recognize when a PLB should be posted to a patient?s account and verify with billing department.Attention to detail when reviewing the EOB correspondence batches in banking system with the ability to identify issues and present to management.
• Interpret and key RAC Audit correspondence into the Audit+ system.Understand payment posting and the relationship between co-pays, deductibles, co-insurance, allowances and payments so that the account balance is accurate after payment is posted.Ability to navigate on various payer websites or call payer directly when needed.
• Key payment data from lockbox work capturing all relevant data including payer remark codes that would assist the Billing Department to determine how to follow up on a denial. Verify that funds are in the bank prior to posting. Import and post files, and reconcile funds in the bank to payments posted. Print posted reports and manually post to the patient billing system any rejected payments and close the receivable to the next responsible payer as warranted.
• Post and reconcile non-sufficient funds, credit files, stop payments and any/all miscellaneous bank account debit adjustments and chargebacks.Verify, import and post electronic remittance/denial files for assigned payers, ensuring that funds are in the bank prior to posting. Identify and communicate to management any unusual delays, balancing issues, new codes or adjustments.
• Manually resolve any rejected payments (post, refund or transfer) for electronic remittance files.Print summary reports. Generate and distribute payer specific electronic posting summary and exception reports to department designee immediately upon completion of payer file run.
• Thoroughly research questionable/unidentified payments in order to post properly. Contact insurance carriers, complete documentation forms and follow up on any amounts posted to suspense, UTL, or clearing accounts. Items posted to suspense, UTL, or clearing accounts must be resolved within 7 days, or notice provided to supervisor of the reason for the extended delay.
• Recognize bad debt transactions and supply proper documentation to ensure bad debt payment is posted accurately into any and all patient billing systems or legacy master spreadsheets.
• Post and/or code non-cash data accurately by selecting the standard code to designate the reason (payment denial, admission approval, refund request, etc). Post memo or contractual adjustment if warranted, and close the receivable to the next payer if warranted.Prepare documentation for payments that must be transferred to another UPMC entity, or refunded to payer. Ensure accurate posting of payments that belong to another UPMC entity or prepare appropriate documentation so that funds can be transferred or refunded.
• Consistently meet departmental productivity standards as set by management.Apply undistributed payments on any and all patient billing following established guidelines.
• Serve as a resource to other employees, as requested by management.Performs HB, PB & SBO payment postings.

Qualifications

• High school diploma required.
• Four years of experience in an accounts receivable environment, preferably in the health care or insurance field.
• Knowledge of payment application, billing and reconciliation.
• Rapid typing/data entry skill and familiarity with personal computer software such as but not limited to Excel.
• Analytic mind that likes to resolve out-of-balance situations and math challenges.
• Associate or B.A. degree in accounting or business preferred.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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