Account Representative Senior

UPMC; Pittsburgh (Allegheny County); On-site; USD 65,000 - 90,000; Full time

Job summary

UPMC Corporate Revenue Cycle is seeking a Senior Account Representative to join the Claims Department in Pittsburgh. The role entails ensuring prompt and correct payments from insurers and patients, with responsibility for accurate claim submission, issue resolution, and timely follow-ups.

The Senior Account Representative will mentor staff, identify recurring problems, and report procedural deficiencies to management while supporting a culture of service excellence within the organization.

Qualifications

• Experience handling multiple payers and preventing posting errors.
• Ability to communicate with insurers, patients, and physicians to resolve payment issues.
• Identify root causes of denials and suggest corrective actions.

Responsibilities

• Perform billing, collections, postings, payments and adjustments with accuracy.
• Verify posting accuracy and work with payers to resolve discrepancies.
• Assist in appeals and follow-up per Revenue Cycle policies.
• Identify issues and submit corrective action recommendations.
• Manage assigned book of business with timely, accurate account closing.

Skills

Payment posting

Denials resolution

Payer communication

Mentoring staff

Independent work

Job description

UPMC Corporate Revenue Cycle is hiring an Account Representative, Senior to join our Claims Department. This position will be based out of Pittsburgh working in the office several times a week.

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.