Claims Specialist

Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician services unit of UHS. IPM develops and manages multi-specialty physician networks and urgent care clinics which align with UHS acute care facilities. It also provides select services for the Behavioral Health division of UHS. Through continuing growth, IPM operates in 11 markets across six states and the District of Columbia. Our leadership team, practitioners, and teams of healthcare professionals are collectively dedicated to improving the health and wellness of people in the communities we serve.

To learn more about IPM visit Physician Services - Independence Physician Management - UHS.

POSITION OVERVIEW

The Claims Specialist is responsible for the accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections.  This includes registration-based edits, claim requirement data edits (e.g. missing admission date), provider enrollment edits (e.g. missing NPI) and payer-specific edits.  Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.  Performs root cause analysis and identifies edit trends timely to minimize lag days, mitigate large volume claim submission delays and maximize opportunities to improve process and update the Practice Management System (PMS) logic as needed.   Exercises good judgement in escalating identified root causes and edit trends to the Billing Supervisor, as needed, to ensure timely resolution and communication to stakeholders.  Demonstrates the ability to be an effective team player. Upholds “best practices” in day to day processes and workflow standardization to drive maximum efficiencies across the team.  Communicates effectively with IPM Coders to handle accurate and timely resolution of coding-based claim edits. 

DUTIES AND RESPONSIBILITIES

• Accurately reviews and resolves assigned claim and clearinghouse edits and payer rejections to minimize lag days.  Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.
• Provides prompt attention to edit trends and identified root causes with timely resolution and escalation to the Billing Supervisor as needed.
• Utilizes real time eligibility verification checks accordingly to accurately update patient registration in the Practice Management System (PMS) for registration-based edits.  Captures registrations error trends and eligibility tool response issues and reports promptly to the Billing Supervisor.
• Initiates support calls to the clearinghouse Help Desk as needed to gain clarification on clearinghouse edits.  Communicates clearinghouse edits that are a roadblock to claim submission, to the Billing Supervisor, so clearinghouse edit/s can be updated as needed.
• Partners with IPM Coders to achieve timely resolution of coding-based claim and clearinghouse edits and payer rejections.
• Effectively prioritizes work assignment/s and demonstrates flexibility in assuming edits assigned to other Claims Specialists to minimize lag days and ensure team goals/objectives are met.
• Participates in regularly scheduled team meetings offering new paths, procedures and approaches to edit resolution to maximize opportunities for performance and process improvement.
• Performs other duties as assigned.

Education:  High School Graduate/GED required.  Technical School/2 Years College/Associates Degree preferred.

Work experience: Experience (3-5 years minimum) working in a healthcare (professional) billing, health insurance or equivalent operations work environment.   

Knowledge:  Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, claim submission requirements.  Understanding of the revenue cycle and how the various components work together preferred.

Skills: Excellent organization skills, attention to detail, research and problem-solving ability.  Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.    Service-oriented/customer-centric.  Strong computer literacy skills including proficiency in Microsoft Office.

Equipment Operated: Mainframe billing software (e.g., Cerner, Epic, IDX) experience highly desirable. 

As an IPM employee you will be part of a first-class organization offering:

• Required to read, write and speak Spanish
• A Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match
• Tuition Reimbursement

and much more!!

Independence Shared Services is not accepting unsolicited assistance from search firms for this employment opportunity.  Please, no phone calls or emails.  All resumes submitted by search firms to any employee via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Shared Services.  No fee will be paid in the event the candidate is hired as a result of the referral or through other means.

 About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $12.6 billion in 2021. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 89,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

EEO Statement

 All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

 Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852- 3449.