UPMC Shadyside Family Health Center is seeking a Full-Time Charge Processing Specialist.
UPMC Shadyside Family Health Center has been teaching doctors to become specialists in family care. Our office serves as the outpatient training site for the Shadyside Family Medicine Residency. We care for patients of all ages, from newborn to geriatric, and provide unique services such as obstetric care, medication assisted therapy, and behavioral health. Our providers, clinical and clerical staff work together to provide high quality care to our patients and find new ways of delivering that care through research and project work.
It is the mission of UPMC Shadyside Family Medicine Residency Program to develop competent and confident Family Physicians to succeed in all domains of Family Medicine. We provide comprehensive training in a rigorous academic environment and pride ourselves on the diversity of our residents, faculty, staff, and patients. We are committed to reducing health disparities through education, inclusive patient experiences, and the advancement of equity and social justice initiatives. Our graduates become patient allies and community partners through their training in evidence-based medicine and patient-centered care. We believe that we can serve our communities and change our world by providing the best care possible for each and every patient.
Daily office operations within the Charge Processing Department, including processing charges, obtaining and entering Managed Care authorizations, attach various modifies to CPT procedure codes, and balancing of charges. Interact with CBO 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. Exercise strict patient confidentiality.
- Ensure physician charges are applied to the correct patient account by verifying information indicated on charge document against system information.
- Assist in the development of the charge processing manuals for each location.
- Verify all charge batches entered are processed with the correct revenue location.
- Coordinate the exchange of information/documentation with other practice plans or ancillary departments.
- 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.
- Perform limited ICD-9 and CPT-4 coding from charge slips, encounter forms, or source documentation.
- Balance charges entered at the end of each day.
- Assure the processing of the clinical charges is entered in order of their clinical significance to maximize reimbursement.
- 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.
- Process charge documents in the Epic system and maintain minimum productivity levels.
- Review coding and charges for accuracy and completeness.
- 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 the charges for bilateral services are processed in accordance with payer specific guidelines.
- Ensure the appropriate modifier is attached at the charge entry level for Medicare non-covered and limited coverage service and for resident participation.
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.
- High school diploma. 2 years 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
UPMC is an Equal Opportunity Employer/Disability/Veteran
Individuals hired into this role must comply with UPMCâ€™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.
UPMC has a Center for Engagement and Inclusion that is charged with executing leading-edge and next-generation diversity strategies to advance the organizationâ€™s diversity management capability and its national presence as a diversity leader. This includes having Employee Resource Groups, such as PRIDE Health or UPMC ENABLED (Empowering Abilities and Leveraging Differences) Network, which support the implementation of our diversity strategy.
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At UPMC, weâ€™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.