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Fraud Waste and Abuse Coding Spec

  • Job ID: 379103493
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Fraud, Waste & Abuse
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $23.75 to $41.09 / hour


UPMC Health Plan's Fraud Waste & Abuse department is seeking a Coding Specialist! This role will perform auditing functions including monitoring and prepayment review for coding of procedures and diagnoses by reviewing medical record documentation to determine if appropriate code was assigned to ensure compliance with coding standards.


  • Utilize standard coding guidelines and principles to verify that the appropriate CPT/HCPCS/ICD-10 codes were assigned including modifiers for correct assignment and accurate reimbursement.
  • Conduct Risk Assessments utilizing Lead Generation Fraud Detection Software to validate referrals, and to identify possible fraud, waste or abuse.
  • Provide coding related support to internal FWA staff.
  • Design and maintain reports, auditing, tools and related documentation.
  • Serve as a representative at internal and external meetings, document and present findings.
  • Participate in all training programs to develop a thorough understanding of the materials presented to the claim and service staff.
  • Participate in special projects including claims and/or coding related audit support.
  • Conduct provider education, as necessary, regarding pre-payment review/audit results
  • Communicate effectively with FWA Staff, nurse reviewers, physicians and ancillary departments as necessary to address issues and concerns


  • Graduate of an approved Health Record Administration or Accredited Medical Record Technician program (RHIA/RHIT or eligible) or a certified coding program.
  • Five (5) years of coding experience in a health care setting. Extensive knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures is required.
  • Three (3) years of claims and/or general auditing experience
  • In depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required.
  • The ability to problem solve and to communicate in a professional manner with staff and other health care professionals is essential. Excellent written and verbal communication skills are essential.
  • Proficiency in computer skills required for coding (MARS, Cerner).
  • Detail oriented individual with excellent organizational skills.
  • High degree of oral and written communication skills.Proficiency in MS Office/PC skills.
  • Traveling may be required as necessary.
  • EDUCATIONAL/KNOWLEDGE PREFERENCES:Bachelors Degree or equivalent education/experience


  • Licensure, Certifications, and Clearances:


  • Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)
  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’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.

   Current UPMC employees must apply in HR Direct

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