UPMC Rx Partners is looking for a full time Billing/Collections Specialist to join their dedicated team!
You will provide for the timely control, submission, collection, and analysis of all third party payor accounts. Provide for the on-going analysis of insurance verification, billing and collection efforts to insure a timely resolution of accounts. Make sound financial decisions to facilitate the resolution of third party accounts based on the information gathered from such sources at third-party insurers, physicians, hospital personnel, governmental agencies, lawyers and patients, the Billing/Collections Specialist.
This role will work weekdays, 9:30am - 5pm. One weekend shift, every fifth weekend.
UPMC offers a generous benefits package, an expansive total rewards package, opportunity to grow your career and much more!
Responsibilities:
- Assist in the development and maintenance of positive working relationships between the receivable team and nursing home facility personnel.
- Interact with the Nursing Home 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 Supervisor, CEO and Nursing Home.
- Adhere to the UPMC Health System and Patient Business Services Standards of Conduct.
- Observe both UPMC HS and Rx Partners-LTC policies and procedures.
- Maintain both 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 the guidelines established 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, nursing home facilities and patients and/or their representatives.
- Attend compliance training program as defined in the compliance training policy and assist in monitoring compliance within 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 to the final resolution of the account.
- Analyze patient accounts with respect to potential problems and develop an appropriate collection strategy.
- Pursue information in an aggressive, 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:
UPMC is an Equal Opportunity Employer/Disability/Veteran