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Purpose:

Responsible for all fiscal functions necessary to ensure the prompt and correct payment to the provider of all monies owed by insurers. Communicate with insurance companies, patients, physicians, and vendors regarding payment issues and recommend write-offs according to UPMC policies. Responsible for working edits/accounts, reviewing posting and balancing of payment/denial and adjustment transactions necessary for closing accounts. Responsible for account balances according to their respective payer when applicable, and for timely and accurate billing in accordance with Third Party regulations.

Responsibilities:

+ Evaluate and recommend referrals to agency, law firm, financial assistance and bad debt

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

+ Demonstrate knowledge of the current functionality of the patient accounting system

+ Ability to perform peer to peer training

+ Identify issues and submit corrective action recommendations

+ Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies.

+ Ability to understand complex reimbursement issues

+ Proficient working multiple disciplines

+ 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.

+ Actively engaged in process improvement for efficiency gains.

+ Able to review complex issues, determine the root cause issue and present a solution

+ 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.

+ Ability to work independently with minimal supervision

+ Understand third party billing and collection guidelines

+ 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.

HS/Equivalent and 2 years of healthcare billing, registration, or patient business services or 5 years' experience in a business office setting OR BS and 1 year experience in a business office setting OR equivalent combination of education and experience required.

Knowledge of medical terminology, third party payor guidelines and reimbursement practices, and available financial resources for payment of balances due. Good computer skills, including spreadsheet application and word processing.

Licensure, Certifications, and Clearances:

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UPMC is an Equal Opportunity Employer/Disability/Veteran