Account Representative Sr

UPMC; Washington (Washington County); On-site; USD 55,000 - 75,000; Full time

Job summary

UPMC in the United States is seeking a Senior Account Representative to manage billing, posting, and collections across multiple payers, ensuring timely and accurate payments to the hospital.

The role mentors staff, identifies recurring issues, and partners with insurers, patients, and physicians to resolve payment problems and optimize the revenue cycle.

This position emphasizes independent work, quality assurance, and adherence to organizational standards.

Qualifications

• Experience in accounts receivable, billing and collections processes.
• Ability to communicate with insurers, patients and physicians to resolve payment issues.
• Knowledge of denials management and posting accuracy.

Responsibilities

• Perform duties in line with service excellence and hospital standards.
• Verify accuracy of payment posting and reimbursement.
• Work with payers or departments to resolve payment discrepancies.
• Identify root cause issues and recommend corrective actions to prevent future denials.
• Assist in claim appeal processes and follow-up per Revenue Cycle policies.
• Manage assigned book of business ensuring timely, accurate billing and postings.
• Evaluate referrals to agencies and other departments as needed.
• Understand third-party billing and payment guidelines.
• Work independently with minimal supervision and meet QA benchmarks.

Skills

Accounts receivable

Billing & collections

Customer communication

Problem solving

Mentoring staff

Tools

Accounting software

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.