At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds.

Our recruiters will continue to fill positions throughout this time, but interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Retrospective Appeals Coder

  • Job ID: 997489456
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 90% remote after training
  • Shift: Day Job
  • Facility: UPMC Pinnacle Hospitals
  • Department: Health Info-Admin-HBG
  • Location: 111 South Front Street, Harrisburg PA 17105
  • Union Position: No
  • Salary Range: $27.17 to $42.45 / hour

Description

UPMC is excited to be hiring a Retrospective Appeals Coder. Training located in Harrisburg, then position would be 90% remote.

Purpose:
The Retrospective Appeal Coder provides support to the local coding departments by initiating the retrospective appeal process for coding denials. Drawing on a coding knowledge base and knowledge of payor regulations, the Retrospective Appeal Coder is responsible for assessing for the presence of criteria to recover denied reimbursement through appeal.

Responsibilities:

 

  • Assist in determining system-wide coding needs through investigation of retrospective denials and identification of root cause. Review and resolve pre-bill edits as needed
  • Maintain current knowledge of regulatory guidelines related to retrospective appeals.
  • Serve as a liaison between coding and payors and facilitates payor/physician contact when indicated.
  • Maintain collaborative relationships with coding management and appeal departments at payor organizations.
  • Collaborate with other departments to ensure all information to support retrospective appeal is identified.
  • Formulate written appeal letter as appropriate incorporating supportive documentation. (i.e. medical criteria, state regulations, etc).
  • Perform coding review for cases referred for retrospective appeal/audits to determine if appeal is warranted.
  • Act as liaison to other departments relative to the retrospective appeal process.
  • Provide ongoing education to coding and other departments related to the appeal process.
  • Ensure the appeal process is followed in order to accomplish timely and appropriate appeals.
  • Identify and assign a root cause to each case to ensure denial reasons are tracked.
  • Monitor and evaluate for areas of process improvement related to the retrospective appeal process.

 

Qualifications

  • Bachelor's degree in Business Administration or related field or Registered Record Administrator (RAA) is preferred.
  • Clinical Document Specialist/Clinical validation of coding experience is preferred
  • 5 years Coding Experience required.
  • Extensive knowledge of DRG/APC, ICD-9/10, CPT/HCPCS classifications and coding of diagnosis and procedures is required.
  • Knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology is required.
  • Prior appeal/grievance experience preferred.


Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days.
 

  • Certified Coding Specialist (CCS) OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT)
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • 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 — 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