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Job Description

Job Title: Senior Manager, Patients Accounts Follow Up/Denial Management
Job ID: 820417122
Status: Full-Time
Regular/Temporary: Regular
Hours: Monday through Friday, 7:30 a.m. to 4:00 p.m.
Shift: Day Job
Facility: Pinnacle Health Support Services
Department: Patient Accounts
Location: 409 South Second Street, Harrisburg PA 17104

Description

Purpose:
Under the direction of the Director, Hospital Patient Accounts; the Senior Manager, Hospital Patient Accounts Follow Up and Denial Management is primarily responsible for the coordination and management of all accounts with open balances to ensure they are paid expeditiously for all UPMC Pinnacle Health System hospitals, with total collections in excess of $1 billion annually from insurers. These responsibilities include management of denials and follow up of unpaid or incorrectly paid claims to ensure UPMC Pinnacle Health is collecting the appropriate reimbursement from third party payors on a timely basis. He/she coordinates the activity of the Patient Accounts Dept. with the Patient Financial Support Services Dept. and other hospital departments, (Patient Access, Health Information, and Utilization Management) and third party payors.

Responsibilities:
  • Primary Duties: Ensures denials are worked timely and accurately in order to obtain payment from payers. Ensures follow up occurs timely and appropriately on unpaid or underpaid claims in order to obtain full payment from payers. In coordination with the Reimbursement department verifies that third party payments are in accordance with contract terms and takes the necessary steps to address discrepancies. Initiates and coordinates appeals as needed.  Initiates and facilitates discussions with third party payors to discuss resolution of discrepancies. Ensures overpayments are worked timely (within 60 days for Medicare claims) and refunds or claim corrections are completed. Ensures all other credit balances are worked timely and appropriate action is taken to resolve credits. Ensures procedures are in compliance with regulations for government programs. Ensures procedures correlate with contractual agreements with third party payors. Assists Managers in resolving issues and takes over the resolution of issues that are not readily resolved and are ongoing.
  • Assists Managers in researching to determine the cause when insurance payments are below the monthly goal. Monitors and interprets changes in third party regulations and requirements. Establishes and maintains positive and effective communication channels with third party payors. Reviews departmental reports and dashboards such as accounts receivable aging, denials, credit balances, productivity and write offs as they relate to insurance claims, on a daily, weekly or monthly basis and takes the appropriate actions to ensure timely collections from the payors. Attends meetings and schedules meetings as needed with other department leaders to facilitate process change/improvement. Hires Managers and ensures proper hiring and supervision of a team of over 60 FTEs. Establish staff productivity measurements and monitoring in addition to evaluating performance of staff.
  • Secondary Duties: Identifies the need for departmental policies and the writing there of. Assists Managers in developing and improving processes and procedures. Makes recommendations for updating Job Descriptions and Performance Standards when necessary. Communicates process changes to the management team for proper implementation and distribution. Performs other duties as assigned by the Director, Hospital Patient Accounts. Schedules and facilitates department meetings to inform staff of changes in processes, review goals and financial metrics and to provide in-service training. Facilitates team activities by assessing needs for team building and team development within Patient Accounts dept. Works with staff to develop their skills and mentor them.
  • Human Relations / Contact and Communications: The Senior Manager, Hospital Patient Accounts Follow Up and Denial Management, has contact with Managers and Directors within the UPMC Pinnacle Health System. He/she has significant contact with third party personnel, governmental representatives and other individuals transacting business with the System. On a departmental basis, the Senior Manager, Hospital Patient Accounts Follow Up and Denial Management, has significant interaction with subordinates. This position requires the ability to work with a large diverse staff. The interaction, which takes place, must be effective with both the exempt and non-exempt staff.

Qualifications

  • Required Knowledge, Skills and Abilities: B.S. in Business Administration or health care related filed OR 3 years of experience performing the exact functions of this role. 
  • Progressive claims processing experience in a large healthcare system required. 
  • Minimum of 7 years of experience in healthcare required.
  • 5 years of management and supervisory experience required. 
  • Must be able to plan and manage area of responsibility. 
  • Must have experience with personal computers. 
  • Must have good oral and written communication skills.
  • Must have strong problem solving skills to approach situations in an imaginative, innovative, interpretive and analytical manner. 
  • Must be able to make effective decisions in challenging situations.
  • Demonstrated ability to motivate staff.
  • Demonstrated team building ability. 
  • Knowledge of all phases of the revenue cycle.
  • Ability to analyze workload and establish staff performance expectations.
  • Preferred Knowledge, Skills and Abilities: Certified Revenue Cycle Executive (CRCE) or Certified Revenue Cycle Professional (CRCP)

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

    Salary Range: $40.34 to $60.52 / hour

    Union Position: No

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