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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire and is required after employment begins. Medical and religious exemption requests may be submitted for consideration.

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

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Account Representative Senior (Claims Integrity Team)

  • Job ID: 434073027
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Revenue Cycle
  • Department: Rev Cyc Claims
  • Location: 2 Hot Metal Street, Pittsburgh PA 15203
  • Union Position: No
  • Salary Range: $15.88 to $24.98 / hour

Description

UPMC Corporate Revenue Cycle is hiring an Account Representative Senior to join our Claims Integrity Team!  This role will work Monday through Friday during business hours.  The position does have flexibility on the start time.   The role will work at the Quantum I building as well work from home opportunities. 

The Account Representative, Senior is responsible for all fiscal functions necessary to ensure the prompt and correct payment to the hospital of all monies owed by both insurers and patients. Account Representatives, Senior are responsible to: ensure claims are submitted accurately and timely; communicate with insurance companies, patients and physicians regarding payment issues; establish reasonable payment arrangements; recommend adjustments according to UPMC policies; review the posting and balancing of payment/denial and adjustment transactions necessary for closing accounts; identify and assign appropriate status codes; and review high dollar accounts on a regular basis. The Account Representative is expected to identify recurring problems and procedural deficiencies that need to be reported to management and to serve as a key mentor to staff for training and procedural direction.

Ready for the next step in your career?  If so, apply today!

Responsibilities:

 

  • Perform duties and job responsibilities in a fashion which coincides with the service management philosophy of UPMC Health System, including the demonstration of The Basics of Service Excellence towards patients, visitors, staff, peers, physicians and other departments within the organization.
  • Ability to work multiple payers
  • Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies.
  • Identify root cause issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. Assist in claim appeal process and/or perform follow-up in accordance with Revenue Cycle policies and procedures.
  • Managed assigned book of business by ensuring the timeliness and accuracy of billing, collections, contractual postings, payments and adjustments of accounts based upon their functional area standards.
  • Evaluate and recommend referrals to agency, law firm, Financial Assistance and Bad Debt.
  • Understand third party billing and collection guidelines
  • Demonstrate knowledge of the current functionality of the patient accounting systems.
  • Identify issues and submit corrective action recommendations.
  • Ability to work independently with minimal supervision
  • Meet quality assurance benchmark standards and maintain productivity levels as defined by management.

 

Qualifications

  • Must have one year of claims/billing/collections experience; OR four years in a business office setting; OR a Bachelors Degree; OR an equivalent combination of education and experience.
  • Excellent interpersonal, organizational, communication and effective problem solving skills are necessary.
  • Must be able to communicate with patients, payers, outside agencies, and general public through telephone, electronic and written correspondence.
  • Prior working experience on personal computers, electronic calculators and office equipment is needed.
  • Must be multi-disciplined in billing, collections, denials, credit balances and/or the various payers.
  • Prior collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.
  • Familiarity with third party payer guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
  • This position requires organization and time management skills.
  • The incumbent must develop and manage relationships with colleagues in a professional, independent manner.
  • The position requires the ability to maintain confidentiality with regard to all assignments.


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