Description

Purpose:
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:

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

Qualifications

• Bachelor's degree OR 3-5 years experience as in a medical billing department and/or 3-5 years experience in accounts receivable environment.
• Strong interpersonal, communication and collection skills required.
•  Knowledge of all third-party payors (Medicare, Blue Cross, Medical Assistance, Commercial, etc.), and the applicable reimbursement practices and familiar with automated patient billing systems.
• History of successful third-party collection skills and decision-making capabilities, preferably in a primary care and/or inpatient billing department.
• 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

UPMC is an Equal Opportunity Employer/Disability/Veteran

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