Description

Provide for the timely control, submission, collection, and analysis of all third party payor accounts. Provide for the on-going analysis of insurance verification, billing and collection efforts to insure a timely resolution of accounts. Make sound financial decisions to facilitate the resolution of third party accounts based on the information gathered from such sources at third-party insurers, physicians, hospital personnel, governmental agencies, lawyers and patients, the Billing/Collections Specialist.

Responsibilities:

• Assist in the development and maintenance of positive working relationships between the receivable team and nursing home facility personnel.
• Interact with the Nursing Home personnel to ensure the cooperative flow of insurance and financial information on patients.
• Guide and motivate people and have the expertise to recognize, analyze and resolve problems and inefficiencies in the billing/collection process.
• Communicate pertinent reimbursement issues in a timely manner to Supervisor, CEO and Nursing Home.
• Adhere to the UPMC Health System and Patient Business Services Standards of Conduct.
• Observe both UPMC HS and Rx Partners-LTC policies and procedures.
• Maintain both yourself and your work in a manner consistent with a professional environment.
• Analyze systems and procedures that affect the efficient billing and collection of accounts and recommend and implement needed changes.
• Provide assistance to other department personnel as required through the direction of your supervisor.
• Negotiate discounts and/or settlements according to the guidelines established and refer any exceptions to management as appropriate.
• Adhere to Fair Debt Collection Practices Act guidelines.
• Facilitate prompt resolution of accounts by communicating with all concerned parties, including third-party insurers, nursing home facilities and patients and/or their representatives.
• Attend compliance training program as defined in the compliance training policy and assist in monitoring compliance within area of responsibility.
• Maintain logs for month-end reporting purposes, such as potential collection problem accounts, reimbursement issues, high dollar accounts, etc.
• Pursue the collection of pharmacy accounts from the point of adjudication to the final resolution of the account.
• Analyze patient accounts with respect to potential problems and develop an appropriate collection strategy.
• Pursue information in an aggressive, yet highly professional manner.

Qualifications

• A Bachelor's degree; or 3-5 years experience as a retail pharmacy technician or 3-5 years experience in pharmacy accounts receivable environment
• Strong interpersonal, communication and collection skills requiredKnowledge of all third-party payors (Medicare, Blue Cross, Medical Assistance, Commercial, etc.), the applicable reimbursement practices and familiar with automated patient billing systems
• History of successful third-party collection skills and decision-making capabilities, preferably in long term care or retail pharmacy
• Ability to communicate with patients, payors, government offices, etc. through face to face, telephone and written correspondence
• Ability to act independently in a decisive and timely manner
  
  Licensure, Certifications, and Clearances:
  

Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; 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.