Account Representative
4 days ago
As a key member of the UPMC team, the Account Representative will be responsible for managing all fiscal functions necessary to ensure the prompt and correct payment to the hospital of all monies owed to the provider by insurers and patients. This includes ensuring claims are submitted accurately and timely, communicating with insurance companies, patients, and physicians regarding payment issues, establishing reasonable payment arrangements, and recommending adjustments according to UPMC policies.
Responsibilities:- Third Party Billing and Collection Guidelines: Understand and apply third-party billing and collection guidelines to ensure accurate and timely payment.
- Root Cause Analysis: Identify root cause issues and recommend corrective action steps to eliminate future occurrences of denials.
- Claim Appeal Process: Assist in the claim appeal process and perform follow-up in accordance with Revenue Cycle policies and procedures.
- Service Management Philosophy: Perform duties and job responsibilities in a fashion that 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.
- Referral and Verification: Evaluate and recommend referrals to agency, law firm, Financial Assistance, and Bad Debt, and verify accuracy of payment posting and reimbursement.
- Patient Accounting Systems: Demonstrate knowledge of the current functionality of the patient accounting systems and 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.
- Quality Assurance and Productivity: Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
- Corrective Action Recommendations: Identify issues and submit corrective action recommendations.
Requirements: High school graduate or equivalent. Excellent interpersonal, organizational, communication, and effective problem-solving skills are necessary. Ability to communicate with patients, payors, outside agencies, and the general public through telephone, electronic, and written correspondence. Working experience on personal computers, electronic calculators, and various office equipment is needed. Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred. Familiarity with third-party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
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