Account Representative Sr

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 60,000 - 75,000; Full time

Job summary

UPMC is seeking an Account Representative, Senior to manage fiscal functions ensuring prompt payments from insurers and patients. You will verify payment postings, resolve discrepancies with payers, and identify denials to drive corrective actions.

You will oversee a book of business, collaborate with departments, and mentor staff on Revenue Cycle procedures, aiming for accurate accounting and timely closure of accounts.

Qualifications

• Experience handling multiple payers and payer policies.
• Ability to identify denial root causes and recommend corrective actions.
• Ability to work independently with minimal supervision and meet QA benchmarks.

Responsibilities

• Verify accuracy of payment posting and reimbursement; resolve discrepancies with payers.
• Identify root cause issues and propose corrective actions to prevent future denials.
• Manage assigned book of business with timely billing, collections, and adjustments.
• Assist in referrals to agency, law firm, Financial Assistance as needed.
• Serve as a mentor to staff for training and procedural direction.

Skills

Multi-payer experience

Payment posting accuracy

Root cause analysis

Independent work

Customer service

Education

Bachelor's degree or equivalent

Tools

Patient accounting systems

Job description

Purpose: 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 to: ensure claims are submitted accurately and timely; communicate with insurance companies, patients and physicians regarding payment issues; establish reasonable payment arrangements; recommend adjustments according to UPMC policies; review the posting and balancing of payment/denial and adjustment transactions necessary for closing accounts; identify and assign appropriate status codes; and review 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 which 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.