Billing/Collections Specialist, Rx Partners - University of Pittsburgh Medical Center : Job Details

UPMC Rx Partners is looking for a full time Billings/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 9 am to 5:30 pm, Monday through Friday, as well as one Saturday every five weeks.

UPMC offers a generous benefits package, an expansive total rewards package, opportunity to grow your career and much more. Apply today!

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.

Qualifications:

* 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