Billing/Collections Specialist, Full Time Hybrid

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 42,000 - 54,000; Full time

Job summary

UPMC Community Pharmacy is seeking a full-time Billing/Collections Specialist to join the team in Pittsburgh, PA. This hybrid role follows a Monday-Friday daylight schedule from 8:30 a.m.

to 5:00 p.m., with no weekend or holiday requirements. The specialist will bill, collect, analyze third-party payer accounts for retail pharmacy services and act as a liaison between pharmacies, insurers, patients and internal staff to ensure accurate reimbursement and timely resolution.

Qualifications

• Bachelor's degree or equivalent experience.
• 3–5 years as a retail pharmacy technician.
• 3–5 years in pharmacy accounts receivable.
• Strong interpersonal, communication and collection skills.
• Knowledge of all third-party payors and reimbursement practices.

Responsibilities

• Assist in developing positive relationships between the receivable team and retail pharmacy staff.
• Interact with retail staff to ensure flow of insurance and financial information.
• Analyze billing processes to identify inefficiencies and opportunities for improvement.
• Negotiate discounts or settlements according to guidelines and escalate exceptions as needed.
• Maintain compliance with Fair Debt Collection Practices Act and internal standards.
• Pursue the collection of pharmacy accounts from adjudication through final resolution.

Skills

Analytical skills

Communication skills

Interpersonal skills

Collection skills

Problem solving

Education

Bachelor's degree

Job description

UPMC Community Pharmacy is seeking a full time, hybrid Billing/Collections Specialist to join the team! This position follows a Monday through Friday daylight schedule of 8:30 a.m. to 5:00 p.m., with no weekend or holiday requirements! This is a hybrid opportunity based out of UPMC Community Pharmacy at 1860 Centre Avenue in Pittsburgh, PA, with a work arrangement ranging from approximately 50% to 90% remote depending on business and departmental needs.

The Billing & Collections Specialist is responsible for the timely billing, collection, resolution, and analysis of third-party payer accounts for retail pharmacy services. This role serves as a key liaison between pharmacies, insurance companies, patients and their representatives, and internal stakeholders to ensure accurate reimbursement and efficient account resolution.

The ideal candidate will possess strong analytical, problem-solving, and communication skills while maintaining a high level of professionalism in a fast-paced healthcare environment.

Key Responsibilities

• Assist in the development and maintenance of positive working relationships between the receivable team and retail pharmacy personnel.
• Interact with retail pharmacy personnel to ensure the cooperative flow of insurance and financial information on patients.
• Guide and motivate people and have the expertise to recognize, analyze, and resolve problems and inefficiencies in the billing/collection process.
• Communicate pertinent reimbursement issues in a timely manner to the Supervisor, Managers, and Director.
• Adhere to the UPMC Health System and Patient Business Services Standards of Conduct.
• Observe both UPMC Health System and retail pharmacy policies and procedures.
• Maintain yourself and your work in a manner consistent with a professional environment.
• Analyze systems and procedures that affect the efficient billing and collection of accounts and recommend and implement needed changes.
• Provide assistance to other department personnel as required through the direction of your supervisor.
• Negotiate discounts and/or settlements according to established guidelines and refer any exceptions to management as appropriate.
• Adhere to Fair Debt Collection Practices Act guidelines.
• Facilitate prompt resolution of accounts by communicating with all concerned parties, including third-party insurers, retail pharmacy personnel, patients, and/or their representatives.
• Attend compliance training programs as defined in the compliance training policy and assist in monitoring compliance within your area of responsibility.
• Maintain logs for month-end reporting purposes, such as potential collection problem accounts, reimbursement issues, high-dollar accounts, etc.
• Pursue the collection of pharmacy accounts from the point of adjudication through final resolution.
• Analyze patient accounts to identify potential issues and develop appropriate collection strategies.
• Pursue information in an assertive, yet highly professional manner.
• A Bachelor's degree; or
• 3-5 years experience as a retail pharmacy technician or
• 3-5 years experience in pharmacy accounts receivable environment
• Strong interpersonal, communication and collection skills required
• Knowledge of all third-party payors (Medicare, Blue Cross, Medical Assistance, Commercial, etc.), the applicable reimbursement practices and familiar with automated patient billing systems
• History of successful third-party collection skills and decision-making capabilities, preferably in long term care or retail pharmacy
• Ability to communicate with patients, payors, government offices, etc. through face to face, telephone and written correspondence
• Ability to act independently in a decisive and timely manner

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran