Billing/Collections Specialist, Full Time Hybrid

Billing/Collections Specialist

UPMC Community Pharmacy is seeking a full time, hybrid Billing/Collections Specialist to join the team! This position follows a Monday through Friday daylight schedule of 8:30 a.m. to 5:00 p.m., with no weekend or holiday requirements! This is a hybrid opportunity based out of UPMC Community Pharmacy at 1860 Centre Avenue in Pittsburgh, PA, with a work arrangement ranging from approximately 50% to 90% remote depending on business and departmental needs.

The Billing & Collections Specialist is responsible for the timely billing, collection, resolution, and analysis of third-party payer accounts for retail pharmacy services. This role serves as a key liaison between pharmacies, insurance companies, patients and their representatives, and internal stakeholders to ensure accurate reimbursement and efficient account resolution.

The ideal candidate will possess strong analytical, problem-solving, and communication skills while maintaining a high level of professionalism in a fast-paced healthcare environment.

Key Responsibilities

• Assist in the development and maintenance of positive working relationships between the receivable team and retail pharmacy personnel.
• Interact with retail pharmacy 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 the Supervisor, Managers, and Director.
• Adhere to the UPMC Health System and Patient Business Services Standards of Conduct.
• Observe both UPMC Health System and retail pharmacy policies and procedures.
• Maintain 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 established guidelines 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, retail pharmacy personnel, patients, and/or their representatives.
• Attend compliance training programs as defined in the compliance training policy and assist in monitoring compliance within your 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 through final resolution.
• Analyze patient accounts to identify potential issues and develop appropriate collection strategies.
• Pursue information in an assertive, 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