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. This position was formerly identified as a Financial Counselor under Pinnacle Health Hospitals.
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.
- Refrain 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.
- Will be responsible for assisting all financial counselors in creating estimates for the Cosmetic and split cosmetic insurance procedures in Work queues
- Will also be responsible to work closely with the Provider offices of the employed and non employed providers scheduling cosmetic procedures.
- Collecting monies for both Hospital and employed Providers if Price Estimate Analyst is unavailable
- Working with the Operating Rooms to split cosmetic and medical accounts - create new Hospital Account, etc..
- Coding Department to be sure coding is accurate between the insurance bill and cosmetic bill
- Work queues - multiple in resolving cosmetic holds. Adding adjustments, billing for additional monies if due, any additional needs to resolve accounts
- Accounts that have Cosmetic on for "special lens" rates collected
- Also responsible to work Bariatric Self Pay procedures
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.
UPMC is an Equal Opportunity Employer/Disability/Veteran
Total Rewards
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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.
