AR Account Specialist

UPMC; Pittsburgh, Northern (Allegheny County, KY); On-site; USD 55,000 - 75,000; Full time

Job summary

UPMC is seeking a Revenue Cycle Specialist to oversee all fiscal functions ensuring prompt and accurate payments from insurers and patients. You will work with insurers, patients, physicians, and vendors to resolve payment issues and apply write-offs per UPMC policy.

This role requires reviewing postings, balancing transactions, and ensuring timely billing in accordance with third-party regulations. You will identify root causes of denials, assist in appeals, and participate in process

Responsibilities

• Evaluate referrals to agencies or law firms and financial assistance.
• Meet quality benchmarks and maintain productivity as defined by management.
• Understand patient accounting system functionality and routines.
• Provide peer-to-peer training when needed.
• Identify issues and suggest corrective actions.
• Verify accuracy of payment posting and resolve discrepancies with payers.
• Understand complex reimbursement issues and multi-discipline workflows.
• Identify root causes of denials and propose preventive actions.
• Assist in claim appeals and follow-up per Revenue Cycle policies.
• Participate in process improvements for efficiency gains.
• Manage billing, collections, postings, and adjustments per standards.
• Work independently with minimal supervision.
• Follow third-party billing and collection guidelines.
• Contribute to service excellence for patients, visitors, and staff.

Job description

Purpose: Responsible for all fiscal functions necessary toensure the prompt and correct payment to the provider of all monies owed by insurers. Communicate with insurance companies, patients, physicians, and vendors regarding payment issues and recommend write-offs according to UPMC policies. Responsible for working edits/accounts, reviewing posting and balancing of payment/denial and adjustment transactions necessary for closing accounts. Responsible for account balances according to their respective payer when applicable, and for timely and accurate billing in accordance with Third Party regulations.

Responsibilities:

• Evaluate and recommend referrals to agency, law firm, financial assistance and bad debt
• Meet quality assurance benchmark standards and maintain productivity levels as defined by management.
• Demonstrate knowledge of the current functionality of the patient accounting system
• Ability to perform peer to peer training
• Identify issues and submit corrective action recommendations
• Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies.
• Ability to understand complex reimbursement issues
• Proficient working multiple disciplines
• 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.
• Actively engaged in process improvement for efficiency gains. Able to review complex issues, determine the root cause issue and present a solution
• 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.
• Ability to work independently with minimal supervision
• Understand third party billing and collection guidelines
• 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.