Account Representative Senior

UPMC; Pittsburgh (Allegheny County); Remote; USD 55,000 - 70,000; Full time

Benefits offered by this job

Work from home

Job summary

UPMC is seeking a Senior Account Representative to join the Claims Department. The role supports prompt hospital payments from insurers and patients and offers a work-from-home option. Responsibilities include accurate posting, payer communication, and managing high-dollar accounts.

The Senior Account Representative will mentor staff, identify process gaps, and ensure compliance with UPMC Revenue Cycle policies. Experience with ICD-9/ICD-10 and billing guidelines is preferred.

Qualifications

• 1 year of claims/billing/collections experience or equivalent combination of education/experience.
• Strong interpersonal and communication skills.
• Ability to work with multiple payers and online systems.

Responsibilities

• Verify accuracy of payment posting and reimbursement; resolve discrepancies with payers.
• Identify root causes of denials and propose corrective actions.
• Assist in claim appeals and follow-ups per Revenue Cycle policies.
• Manage assigned book of business ensuring timely billing, collections, and postings.
• Maintain confidentiality and demonstrate professional conduct.

Skills

Claims experience

Billing knowledge

Communication skills

Problem solving

Time management

Tools

Patient accounting systems

Job description

UPMC Corporate Revenue Cycle is hiring an Account Representative, Senior to join our Claims Department. This position will have the opportunity to work from home.

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. Account Representatives, Senior are responsible for 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 Account Representative, Senior is expected to identify recurring problems and procedural deficiencies that need to be reported to management and to serve as a key mentor to staff for training and procedural direction.

Responsibilities:

• 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.

• Ability to 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.

• Managed 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.

• Ability to work independently with minimal supervision

• Meet quality assurance benchmark standards and maintain productivity levels as defined by management.

• Must have 1 year of claims/billing/collections experience; OR 4 years in a business office setting; OR a Bachelors Degree; OR an equivalent combination of education and experience.

• Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.

• 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 is needed.

• Must be multi-disciplined in billing, collections, denials, credit balances and/or the various payers.

• Prior collections or medical billing experience with basic understanding of ICD9, CPT4, 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.

• This position requires organization and time management skills.

• The incumbent must develop and manage relationships with colleagues in a professional, independent manner.

• The position requires the ability to maintain confidentiality with regard to all assignments.

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran