Billing/Collections Specialist, Rx Partners

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:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran