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 include ensuring claims are submitted accurately and timely; communicating with insurance companies, patients and physicians regarding payment issues; establishing reasonable payment arrangements; recommending adjustments according to UPMC policies; reviewing the posting and balancing of payment/denial and adjustment transactions necessary for closing accounts; identifying and assigning appropriate status codes; and reviewing high dollar accounts on a regular basis. The position also involves identifying recurring problems and procedural deficiencies to report to management and serving as a key mentor to staff for training and procedural direction.

Responsibilities

• Perform duties in alignment with UPMC Health System’s service management philosophy, demonstrating The Basics of Service Excellence toward patients, visitors, staff, peers, physicians and other departments.
• Verify accuracy of payment posting and reimbursement.
• Work with appropriate payer and/or department to resolve payment discrepancies.
• Identify root cause issues and recommend corrective action steps to eliminate future 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 timeliness and accuracy of billing, collections, contractual postings, payments and adjustments based upon 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 patient accounting systems and submit corrective action recommendations.
• Work independently with minimal supervision.
• Meet quality assurance benchmark standards and maintain productivity levels as defined by management.

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.

Qualifications

• Excellent interpersonal, organizational, communication and effective problem solving skills.
• Ability to communicate with patients, payers, outside agencies and the general public via telephone, electronic and written correspondence.
• Prior working experience on 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 basic understanding of ICD-9, CPT-4, HCPCS, and medical terminology is preferred.
• Familiarity with third party payer guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
• Strong organization and time management skills.
• Ability to develop and manage professional, independent relationships with colleagues.
• Maintain confidentiality with regard to all assignments.

Licensure, Certifications, and Clearances

• Act 34