Job Description

Job Title: Reimbursement Analyst
Job ID: 716723
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Evolent Admin
Location: 600 Grant St, Pittsburgh PA 15219

Description

The Reimbursement Analyst is a middle level analytical position responsible for all aspects of provider reimbursement. This includes establishing and maintaining compensation rates for hospitals, physicians, and ancillary services. Knowledge of fee schedules, case rates, per-diems, RUG III, as well as any other reimbursement methodology is required.

Responsibilities:
  • Act as company expert on all reimbursement issues.
  • Analyze all reimbursement, including outliers, transfer adjustments, etc.
  • Analyze and compare fee schedules.
  • Attend meetings when required.
  • Complete special projects accurately and timely.
  • Monitor Calendar to assure all action items are completed proactively.
  • Monitor and review new pricing configuration to assure the provider is pricing accurately as contracted. This includes maintaining documentation of your review.
  • Out of network negotiations when required.
  • Resolve problems that result in claims pending.
  • Resolve reimbursement issues.
  • Update and maintain hospital reimbursement rate summary.
  • Update and maintain hospital reimbursement reports for all product lines. Reports include inpatient base rate comparisons, outpatient reimbursement comparisons to UPMC OP fee schedule, Observation cost per case.
  • Work with Reimbursement Specialist in developing / negotiating reimbursement rates for new providers. Including accurate, easy to understand analysis of the negotiated rates.
  • Work with configuration staff when negotiating to assure negotiated rates are operational.

Qualifications

  • Bachelors Degree in health care administration, business and/or other related discipline (Related experience in a health care administration setting may be substituted for educational requirements).
  • Excellent planning, communication, documentation, organizational, analytical, and problem solving abilities.
  • Advanced mathematical skills.
  • Ability to interpret and summarize results of various analysis in a timely and meaningful way.
  • Strong computer skills, including expert knowledge of Access and Excel.
  • Experience with a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is preferred.
  • Preferred individual needs to have in depth understanding of managed care delivery systems and have had direct experience with reimbursement.
  • Knowledge of ICD-9CM, CPT4, Revenue Codes, DRGs, base rates, Medicare methodologies, Medicaid methodologies, HCPCS coding and related governmental guidelines and provider reimbursement methodologies preferred.
  • Ability to work cooperatively with multidisciplinary teams and/or independently.

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $17.11 to $28.43

Union Position: No

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