Account Representative Sr

UPMC•Pittsburgh, PA

About The Position

The Account Representative, Senior is responsible for fiscal functions that ensure the prompt and correct payment to the hospital of monies owed by insurers and patients. The role supports accurate and timely claim submission; communication with insurance companies, patients, and physicians about payment issues; reasonable payment arrangements; policy-based adjustment recommendations; review of payment, denial, and adjustment postings and balancing; assignment of appropriate account status codes; and regular review of high-dollar accounts. The Senior Account Representative also identifies recurring problems and procedural deficiencies for management and serves as a mentor to staff by providing training and procedural direction. The position manages an assigned book of business, supporting timely and accurate billing, collections, contractual postings, payments, and account adjustments in accordance with functional-area standards and Revenue Cycle policies. It requires familiarity with multiple payers and patient accounting systems, independent work with minimal supervision, professional relationship management, confidentiality, and achievement of quality and productivity standards. Act 34 clearance is required.

Requirements

At least one year of claims, billing, or collections experience; or four years in a business office setting; or a bachelor’s degree; or an equivalent combination of education and experience.
Excellent interpersonal, organizational, communication, and effective problem-solving skills.
Ability to communicate with patients, payers, outside agencies, and the general public by telephone, electronic communication, and written correspondence.
Prior working experience with personal computers, electronic calculators, and office equipment.
Ability to work across billing, collections, denials, credit balances, and/or various payers.
Organization and time-management skills.
Ability to develop and manage professional relationships with colleagues independently.
Ability to maintain confidentiality regarding all assignments.
Act 34 clearance.

Nice To Haves

Prior collections or medical billing experience with a basic understanding of ICD-9, CPT-4, HCPCS, and medical terminology.
Familiarity with third-party payer guidelines, reimbursement practices, and available financial resources for payment of balances due.

Responsibilities

Perform duties in alignment with UPMC Health System’s service management philosophy and demonstrate The Basics of Service Excellence toward patients, visitors, staff, peers, physicians, and other departments.
Work with multiple payers.
Verify the accuracy of payment posting and reimbursement.
Work with the appropriate payer and/or department to resolve payment discrepancies.
Identify root causes and recommend corrective actions to prevent future denials.
Assist with claim appeals and/or perform follow-up in accordance with Revenue Cycle policies and procedures.
Manage an assigned book of business, ensuring timely and accurate billing, collections, contractual postings, payments, and account adjustments according to functional-area standards.
Evaluate and recommend referrals to an agency, law firm, Financial Assistance, or Bad Debt.
Understand third-party billing and collection guidelines.
Maintain knowledge of current patient accounting system functionality.
Identify issues and submit corrective-action recommendations.
Work independently with minimal supervision.
Meet quality assurance benchmarks and productivity levels defined by management.
Identify recurring problems and procedural deficiencies for management and mentor staff through training and procedural direction.