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UPMC · 10 hours ago

Billing/Collections Specialist, Rx Partners

Bridgeville, PA

Full-time

Onsite

Mid Level

3+ years exp

UPMC Rx Partners is looking for a full time Billing/Collections Specialist to join their dedicated team. This role focuses on the timely control, submission, collection, and analysis of third party payor accounts, ensuring a timely resolution of accounts through effective communication and problem-solving.

BiotechnologyHealth CareHospitalMedical

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

Qualification

Third-party payor knowledgePharmacy accounts receivableCollection strategy developmentInterpersonal skillsCommunication skillsDecision-making capabilitiesCompliance trainingProfessionalism

Required

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