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Purpose:

The AR Specialist Sr focuses on reviewing and resolving insurance denials by submitting corrected claims, appeals, reconsiderations, and redeterminations as appropriate. This position serves as a key resource for staff by providing guidance on complex billing issues, investigating discrepancies, and ensuring compliance with payer-specific policies and coverage guidelines. A strong understanding of insurance regulations, billing practices, and denial management processes is essential for success in this role.

Responsibilities:

+ Ability to perform peer to peer training

+ Go to person for escalated accounts

+ Advanced knowledge of Microsoft Office

+ Ability to communicate with multiple levels of management

+ 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.

+ Verify accuracy of payment posting and reimbursement.

+ Work with appropriate payer and/or department to resolve any payment discrepancies.

+ Understand third party billing and collection guidelines

+ Proficient working multiple payers

+ 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.

+ Demonstrate knowledge of the current functionality of the patient accounting system Identify issues and submit corrective action recommendations

+ Ability to work independently with minimal supervision

+ Ability to understand complex reimbursement issues

+ 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

+ Actively engaged in process improvement for efficiency gains.

+ Able to review complex issues, determine the root cause issue and present a solution that will result in a cost reduction the majority of the time.

+ Meet quality assurance benchmark standards and maintain productivity levels as defined by management.

+ High school diploma or equivalent and 3 years of billing, registration or patient business services or 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 in billing/collections, denials, credit balances and/or various payers.

+ 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:**

+ Act 34 **UPMC is an Equal Opportunity Employer/Disability/Veteran**