Account Representative Sr

About the role

The Account Representative, Senior is responsible for all fiscal functions necessary to ensure the prompt and correct payment to the hospital of all monies owed by both insurers and patients.

Responsibilities

• Ensure claims are submitted accurately and timely
• Communicate with insurance companies, patients and physicians regarding payment issues
• Establish reasonable payment arrangements
• Recommend adjustments according to UPMC policies
• Review the posting and balancing of payment/denial and adjustment transactions necessary for closing accounts
• Identify and assign appropriate status codes
• Review high dollar accounts on a regular basis
• Identify recurring problems and procedural deficiencies that need to be reported to management
• Serve as a key mentor to staff for training and procedural direction
• 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
• Work multiple payers
• Verify accuracy of payment posting and reimbursement
• Work with appropriate payer and/or department to resolve any payment discrepancies
• 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
• Manage 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
• Understand third party billing and collection guidelines
• Demonstrate knowledge of the current functionality of the patient accounting systems
• Identify issues and submit corrective action recommendations
• Work independently with minimal supervision
• Meet quality assurance benchmark standards and maintain productivity levels as defined by management

Qualifications

• 1 year of claims/billing/collections experience; OR 4 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
• Must be able to communicate with patients, payers, outside agencies, and general public through telephone, electronic and written correspondence
• Prior working experience on personal computers, electronic calculators and office equipment
• Must be multi-disciplined in billing, collections, denials, credit balances and/or the various payers
• Organization and time management skills
• Must develop and manage relationships with colleagues in a professional, independent manner
• Ability to maintain confidentiality with regard to all assignments

Preferred qualifications

• Prior collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology
• Familiarity with third party payer guidelines and reimbursement practices and available financial resources for payment of balances due

Licensure, Certifications, and Clearances

• Act 34