Billing/Collections Specialist, Rx Partners

UPMC•Bridgeville, PA

4d•Onsite

About The Position

UPMC Rx Partners is looking for a full time Billing/Collections Specialist to join their dedicated team! You will 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. This role will work weekdays, 9:30am - 5pm. One weekend shift, every fifth weekend.

Requirements

A Bachelor's degree; or 3-5 years experience as a retail pharmacy technician or 3-5 years experience in pharmacy accounts receivable environment
Strong interpersonal, communication and collection skills required
Knowledge of all third-party payors (Medicare, Blue Cross, Medical Assistance, Commercial, etc.), the applicable reimbursement practices and familiar with automated patient billing systems
History of successful third-party collection skills and decision-making capabilities, preferably in long term care or retail pharmacy
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
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Responsibilities

Assist in the development and maintenance of positive working relationships between the receivable team and nursing home facility personnel.
Interact with the Nursing Home personnel to ensure the cooperative flow of insurance and financial information on patients.
Guide and motivate people and have the expertise to recognize, analyze and resolve problems and inefficiencies in the billing/collection process.
Communicate pertinent reimbursement issues in a timely manner to Supervisor, CEO and Nursing Home.
Adhere to the UPMC Health System and Patient Business Services Standards of Conduct.
Observe both UPMC HS and Rx Partners-LTC policies and procedures.
Maintain both yourself and your work in a manner consistent with a professional environment.
Analyze systems and procedures that affect the efficient billing and collection of accounts and recommend and implement needed changes.
Provide assistance to other department personnel as required through the direction of your supervisor.
Negotiate discounts and/or settlements according to the guidelines established and refer any exceptions to management as appropriate.
Adhere to Fair Debt Collection Practices Act guidelines.
Facilitate prompt resolution of accounts by communicating with all concerned parties, including third-party insurers, nursing home facilities and patients and/or their representatives.
Attend compliance training program as defined in the compliance compliance training policy and assist in monitoring compliance within area of responsibility.
Maintain logs for month-end reporting purposes, such as potential collection problem accounts, reimbursement issues, high dollar accounts, etc.
Pursue the collection of pharmacy accounts from the point of adjudication to the final resolution of the account.
Analyze patient accounts with respect to potential problems and develop an appropriate collection strategy.
Pursue information in an aggressive, yet highly professional manner.