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:
- Adhere to Fair Debt Collection Practices Act guidelines.
- Pursue information in an aggressive, yet highly professional manner.
- Analyze patient accounts with respect to potential problems and develop an appropriate collection strategy.
- Facilitate prompt resolution of accounts by communicating with all concerned parties, including third-party insurers, and patients and/or their representatives.
- Deposits payments at bank in a secure and timely manner as needed.
- Pursue the collection of accounts from the point of adjudication to the final resolution of the account.
- 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.
- Assist in the development and maintenance of positive working relationships between the receivable team.
- Interact with personnel to ensure the cooperative flow of insurance and financial information on patients.
- Provide assistance to other department personnel as required through the direction of your supervisor.
- Attend compliance training program as defined in the compliance training policy and assist in monitoring compliance within area of responsibility.
- Guide and motivate people and have the expertise to recognize, analyze and resolve problems and inefficiencies in the billing/collection process.
Qualifications
- High school diploma or equivalent required
- Prefer Associates Degree in Business/Healthcare or two years experience as a secretary
- Three - Five years experience in accounts receivable environment OR equivalent combination of education and experience
KNOWLEDGE, SKILLS & ABILITIES & INTERPERSONAL/LANGUAGE SKILLS
- Knowledge of all third-party payors (Medicare, Blue Cross, Medical Assistance, Commercial, etc.), the applicable reimbursementpractices and familiar with automated patient billing systems
- History of successful third-party collection skills and decision-making capabilities
- 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
- Knowledge of ICD-9 and CPT Coding preferred
- Knowledge of medical terminology preferred
- Must possess a good working knowledge of word processing and spreadsheet software including Word and Excel
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.
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