Account Representative Sr

Purpose: 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

• Perform duties and job responsibilities in alignment with the service management philosophy of UPMC Health System, demonstrating service excellence toward patients, visitors, staff, peers, physicians, and other departments.
• Work with multiple payers to verify accuracy of payment posting and reimbursement.
• Resolve payment discrepancies with appropriate payers and/or departments.
• Identify root cause issues and recommend corrective actions to eliminate future denials.
• Assist in the claim appeal process and perform follow-up in accordance with Revenue Cycle policies and procedures.
• Manage assigned book of business by ensuring timeliness and accuracy of billing, collections, contractual postings, payments, and adjustments based on 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 patient accounting systems and submit corrective action recommendations for identified issues.
• Work independently with minimal supervision.
• Meet quality assurance benchmark standards and maintain productivity levels as defined by management.
• Ensure claims are submitted accurately and timely.
• Communicate with insurance companies, patients, and physicians regarding payment issues.
• Establish reasonable payment arrangements and 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 to report to management.
• Serve as a key mentor to staff for training and procedural direction.

Requirements

• 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 problem-solving skills.
• Ability to communicate with patients, payers, outside agencies, and the general public through telephone, electronic, and written correspondence.
• Prior working experience with personal computers, electronic calculators, and office equipment.
• Multi-disciplined in billing, collections, denials, credit balances, and/or various payers.
• Prior collections or medical billing experience with a basic understanding of ICD-9, CPT-4, HCPCS, and medical terminology is preferred.
• Familiarity with third-party payer guidelines, reimbursement practices, and available financial resources for payment of balances due.
• Strong organization and time management skills.
• Ability to develop and manage professional relationships independently.
• Ability to maintain confidentiality regarding all assignments.

Licensure, Certifications, and Clearances

• Act 34