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

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