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For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Billing Specialist II

Description

Purpose:
Accurately prepares, submits and follows up on all patient claims to various third party payers and/or designated agencies. Analyzes accounts receivable reimbursements, monitors trends and utilizes in-depth problem solving techniques to resolve issues.

Responsibilities:
  • Required to do claims follow up and analysis, reviewing inquiries, correcting claims as appropriate and resubmission of claims for payment. Billing Specialist is expected to complete their work files through PCS and follow up on all outstanding claims which have not be processed or are in need of appeal.
  • Do initial billing through submission of claims to the appropriate third party payers, through electronic process or hard copy mailing, according to the established deadlines and requirements of the payer. When it is necessary request system changes due to changing billing requirements or system problems working in conjunction with supervisor
  • Responsible for recording all action taken on the account in the notes field in the computer system. Responsible for maintaining the integrity of the billing file and all pertinent records and the accurate account adjustments with related documentation.
  • Demonstrates the ability to meet the needs of both the customer and co-workers in a caring, competent manner acting as an information resource to others. Coordinates the flow of communication regarding any third party payer updates and/or changes between other Billing Specialists, Team Leader, Supervisors, Director, Physician Practice Staff and other Departments. Accurately prioritizes information and refers it to appropriate personnel. Maintains confidentiality with respect to any and all information learned through performing this role.
  • Accepts responsibility for personal and professional growth. Attends department meetings (unless otherwise excused). Participates in RHMS and/or Hamot activities and inservices. Maintains documentation of attendance of annual training, mandatory education and age specific criteria. Arrives at workstation ready to work at scheduled time, i.e., start of shift, breaks, lunch, etc.

Qualifications

  • High-school Diploma or equivalent required.
  • Three years previous billing/accounts receivable experience in Healthcare facility or Physician office setting. 
  • One year of in-depth accounts receivable analysis.
  • Knowledge in medical terminology, ICD-9/10 and CPT coding. 
  • Operating knowledge of basic business office equipment. 
  • Demonstrated proficiency in working on computer system. 
  • IDX knowledge preferred. 
  • Must have knowledge of use of Microsoft Excel and Word.
  • Work requires interpersonal skills to effectively communicate with a wide range of people, exchange information on factual matters, understand and transmit instructions. 
  • Interactions require good customer service skills and basic common courtesy.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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.

   Current UPMC employees must apply in HR Direct

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