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Insurance Account Manager

2 months ago

Carlisle, Pennsylvania, United States University of Pittsburgh Medical Center Full time
Job Title: Insurance Account Manager

**About the Role**

At the University of Pittsburgh Medical Center, we are seeking a highly skilled Insurance Account Manager to join our team. As an Insurance Account Manager, you will play a critical role in ensuring seamless patient care and financial management.

**Key Responsibilities**

  • Review patient insurance benefits, reimbursement, and patient responsibility for chemotherapy and adjunctive infusions.
  • Communicate findings with clinical teams and patients to ensure accurate and timely information.
  • Review open accounts to evaluate claim status and intervene to ensure proper payment.
  • Work with patients to determine availability of oncology-specific assistance programs.
  • Perform other duties as assigned, including preparing financial reports and maintaining accurate records.
  • Research and resolve claim rejections and denials, and communicate with insurance companies to resolve issues.
  • Monitor progress of appealed claims and provide updates to providers and patients.
  • Abstract data from medical records to provide accurate and timely information for billing and reimbursement.
  • Work with the Director of Payer Relations to identify services not outlined effectively in payor contracts.
  • Assign codes to diagnoses and procedures according to ICD-9 CM and CPT guidelines.
  • Enter or review outpatient charges using appropriate diagnosis codes and modifiers.
  • Verify that all charges have supporting documentation and review charges for correct coding and accuracy.
  • Audit payments from insurances for compliance with contractual amounts.
  • Maintain knowledge of coding standards and guidelines.
  • Perform liaison functions between the Department Director/Supervisor and Physicians for coding and reimbursement accuracy.
  • Work closely with clinical staff, physicians, and other department stakeholders to ensure accurate and timely information.
  • Assist Supervisor/Director with ongoing education to physicians and others on coding and billing issues.
  • Compare treatment provided in hospital versus physician practice to evaluate reimbursement and patient responsibility.

**Requirements**

  • High school graduate with good mathematical skills.
  • Requires accuracy and attention to detail.
  • Two to three years experience in insurance verification, claim adjudication, medical office billing, or outpatient billing.
  • Preferred knowledge of medical terminology, ICD-9 and CPT coding, and insurance policies and procedures.

**Licensure, Certifications, and Clearances**

  • Act 34