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Manager, Patient Accounts - Follow Up & Denials

Company: UPMC
Location: Harrisburg
Posted on: January 17, 2023

Job Description:

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated. Search Our Jobs Manager, Patient Accounts - Follow Up & Denials

  • Job ID: 074538979
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day JobThe Patient Accounts team is hiring a Manager of Patient Accounts!This position will have work from home flexibility after a 6-9 month training program is completed.Purpose:
    This position is responsible for overseeing and monitoring all team activity as it relates to the timely and accurate follow up of aged accounts and processing of denials, from Non-Government Payers, for all Pinnacle Health System hospitals. The manager utilizes work queues, reports and dashboards to identify and quantify issues relating to aged or denied claims. This position establishes financial and production goals, manages the performance evaluation process and establishes and enforces policies and procedures. They communicate to stakeholders outside the Patient Accounts Department regarding process changes needed for timely adjudication of claims and to be in compliance of payor contracts and requirements.

    • The Patient Accounts unit is a service and production-oriented component of PinnacleHealth Hospitals.
    • The centralized business office allows for communication between work teams.
    • Level 4 need to balance a hands-on approach with staff through managerial responsibilities, which include communication, advocacy, enforcement of policy, and establishment of performance targets.
    • Individuals must be able to succeed in a busy and complex environment.
    • Other duties as assigned.
    • Special projects as assigned.
    • Works to keep staff motivated.
    • Writes, updates and enforces policies and procedures under the direction of the Level 3 management
    • Works with Provider Representatives to resolve billing issues.
    • Works with IT Analysts to recommend program changes to claims and processes due to payer requirements or to gain efficiencies.
    • Develops processes for handling each type of denial, gives guidance to staff on processing appeals and seeks assistance from other departments.
    • Seeks ways for staff to work more effectively and efficiently to decrease aging and denials.
    • Assists Senior Billing Representatives in resolving issues and responding to staff questions and takes on the resolution of issues that can't be resolved by the Senior.
    • Reviews workload on a daily basis and gives direction to staff of changes in work assignments to accommodate any shifts in workload.
    • Coordinates work sessions with management from other departments to review and recommend changes to processes, charges or coding.
    • Monitors denials, determines root causes and communicates issues with management responsible for the root causes.
    • Ensures all activities are in compliance with payer contracts.
    • Remains current on reading and analyzing payer bulletins and communications and takes appropriate action when changes are required.
    • Ensures that accounts with credit balances that have a payment from Medicare, whether primary or secondary, are worked and overpayments from Medicare are refunded or claim corrections are initiated, as defined by CMS, to remain in compliance with Medicare regulations.
    • Establishes and implements procedures to assure accurate and timely follow up of aged accounts, denials, refunds and credit balances.
    • Interviews, hires, disciplines and evaluates the performance of staff.
    • Arranges education, training, and other information sessions.
    • Initiates a quality control process to review staff's work and give feedback to staff.
    • Monitors daily production and gives feedback to staff not meeting productivity requirements.
    • Establishes individual staff goals and expectations.
    • Establishes team goals for working aged accounts, denied claims, refunds and credit balances.Qualifications
      • Minimum of 5 years of experience in healthcare
      • Minimum of 2 years of management or team lead experience
      • Effective written and verbal communication skills.
      • Complete understanding of the health care reimbursement continuum.
      • Manage multiple billing and financial systems and communicate relevance of reports to staff.
      • Compile and present analytics to senior management as they relate to team performance. -
      • A thorough understanding of third-party reimbursement and regulatory requirements.
      • Working knowledge of CPT/HCPCS codes and familiarity with a hospital Charge Master System.
      • Ability to motivate and improve team performance.
      • Ability to analyze workload and establish staff performance expectations.
      • Strong working knowledge of Excel, Word and PowerPoint.
      • Preferred Knowledge, Skills and Abilities:
        • B.A./B.S. preferred
        • Certified Revenue Cycle Executive (CRCE) or Certified Revenue Cycle Professional (CRCP) desirable.
        • Experience with EpicLicensure, Certifications, and Clearances:
          Clearances must be dated within 90 days
          • Act 33 with renewal
          • Act 34 with renewal
          • Act 73 FBI Clearance with renewalUPMC is an Equal Opportunity Employer/Disability/VeteranCOVID-19 Vaccination Information
            Individuals hired into this role must comply with UPMC's COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.
            -Total RewardsMore than just competitive pay and benefits, UPMC's Total Rewards package cares for you in all areas of life - because we believe that you're at your best when receiving the support you need: professional, personal, financial, and more.Our ValuesAt UPMC, we're driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety , Dignity & Respect , Caring & Listening , Responsibility & Integrity , Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today. Current UPMC employees must apply in HR Direct We are aware of scams targeting UPMC and other large companies that involve individuals posing as employees to illegitimately conduct interviews and extend false employment offers and payments to gain access to candidates' personal information. Please note that UPMC will not communicate with candidates through third-party email services like Gmail or Yahoo. While some interviews may take place via a video conferencing service, UPMC Talent Acquisition will not conduct interviews via Skype or Google Hangouts. UPMC will never ask for or disburse funds during the recruitment process. If you are hired into a role with a sign-on bonus or similar incentive, funds will be paid to you by UPMC after your start date.

Keywords: UPMC, Harrisburg , Manager, Patient Accounts - Follow Up & Denials, Executive , Harrisburg, Pennsylvania

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