UPMC Charge Processing Specialist in Indiana, Pennsylvania
Job Summary:UPMC Community Medicine is hiring a Charge Processing Specialist to support the Floyd M. Casaday, M.D. department located in Indiana, PA. The position works daylight hours on Monday through Friday. In this role, you will be responsible for the daily office operations within the department, including processing charges, obtaining and entering Managed Care authorizations, attaching various modifications to CPT procedure codes, and balancing charges. You will interact with billing personnel to provide requested information and to assist in the resolution of billing or insurance issues and/or patient concerns, as well as physicians and other personnel from other practice plans.
Assist in the development of the charge processing manuals for each location.
Assure the processing of the clinical charges is entered in order of their clinical significance to maximize reimbursement.
Balance charges entered at the end of each day.
Coordinate the exchange of information/documentation with other practice plans or ancillary departments.
Document all medical records, which are attached to the charge document, with the date of entry and forward to the Billing Department on a daily basis.
Document all problem charges with date charge was unable to be processed, what specific information is missing, and the user initials and forward to Charge Processing Analyst for resolution.
Ensure Managed Care requirements are met by accessing the referral system and attaching the pre-loaded authorization to the charge being processed. Direct entry of the Managed Care referral into Cadence will be required if the authorization is attached to the charge document upon submission to the Charge Processing Department.
Ensure physician charges are applied to the correct patient account by verifying information indicated on charge document against system information.
Ensure the appropriate modifier is attached at the charge entry level for Medicare non-covered and limited coverage service and for resident participation.
Ensure the charges for bilateral services are processed in accordance with payer specific guidelines.
Perform limited ICD-9 and CPT-4 coding from charge slips, encounter forms, or source documentation.
Process charge documents in the Epic system and maintain minimum productivity levels.
Review coding and charges for accuracy and completeness.
Verify all charge batches entered are processed with the correct revenue location.
Verify the appropriate Place of Service (POS) code is submitted in relation to the rendered procedure Type of Service (TOS) at the charge entry level based on payer specific requirements. The UPP Billing and Coding Departments will supply these payer specific requirements.
High school diploma or equivalent is required.
Two years of experience in registration, scheduling, insurance verification, and charge and payment posting processes, within a physician office practice preferred.
Strong verbal, telephone and written correspondence skills.
Knowledgeable of medical terminology, cash collection and application, ICD-9/CPT-4 coding, and third party payor billing and reimbursement practices.
Ability to effectively problem solve.
Prior working experience on personal computers and various office equipment.
Licensure, Certifications, and Clearances:
- Act 34 Criminal Clearance
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities