Description

Purpose:

A resource for the billing office staff in areas including but not limited to: billing, quality, project support, analytics, and payer guidelines. Identify recurring problems and procedural deficiencies and provide solutions to eliminate them. Interact with the management team and provide suggestions for process improvement.

Responsibilities:

• Maintain a timely schedule of claim creation, account resolution, reviewing all patient and insurance balances monthly. 

• Follow policy and procedures developed for the handling of all client mail, insurance denials, and reimbursement irregularities. 
• Utilize all tools available to ensure reimbursement, including but not limited to, sending of appeals, redeterminations, patient statements, and claim investigations. 
• Analyze patient accounts with respect to potential problems and develop an appropriate collection strategy. 
• Analyze systems and procedures that affect the efficient billing and collection of accounts and recommend and implement needed changes. 
• Pursue information in an aggressive, yet highly professional manner. 
• Facilitate prompt resolution of accounts by communicating with all concerned parties, including third-party insurers, and patients and/or their representatives. 
• Communicate pertinent reimbursement issues in a timely manner to Director and internal team members.
• Adhere to the UPMC Health System and Patient Business Services Standards of Conduct. 
• 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. 
• Adhere to Fair Debt Collection Practices Act guidelines. 
• Attend compliance training program as defined in the compliance training policy and assist in monitoring compliance within area of responsibility.
• Special Projects as needed.

Qualifications

High school diploma or equivalent. Five years of experience in a billing or follow-up role of a healthcare or health insurance organization.  Familiarity and competence on one or multiple billing and patient accounting systems.  A team performance orientation with regard to department, payer, and the ambulatory surgery centers.  An understanding and ability to communicate with third-party reimbursement and regulatory requirements.  Prior use of Microsoft Office applications recommended especially the use of Excel and Word.  Understanding of CPT codes and familiarity with revenue codes, especially related to ASC billing.  Continued education and training to improve the understanding of payer communications, billing systems and analytical software tools.  Additional knowledge relating to surgery center systems and processes.

Licensure, Certifications, and Clearances:

• Act 33
• Act 34
• Act 73

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.

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

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.