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Provider Reimbursement Adjustment Coordinator

  • Job ID: 114849782
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Provider Reimbursement
  • Location: 339 Sixth Avenue, Pittsburgh PA 15222
  • Union Position: No
  • Salary Range: $18.24 to $30.32 / hour

Description

Are you detail-oriented? Do you have a background in medical billing or medical claims? Whether you're looking for a collaborative team setting, a career path that can lead to leadership, an excellent work-life balance, or experience with an industry leader, our Provider Reimbursement Adjustment Coordinator opportunity offers many ways for you to get involved!

The Provider Reimbursement Adjustment Coordinator is a Monday - Friday, daylight role (8:00 a.m. - 4:30 p.m.). Due to COVID-19 circumstances, this will be a hybrid role, with some remote work and some travel into the office. Occasional overtime may be required.

Call center experience and proficiency in Microsoft Excel proficiency is preferred.

Under the direction of the Claims Director of Community Care, the Provider Reimbursement Adjustment Coordinator will be responsible for overseeing the processing of all claims by the claims processing vendor.

 


Responsibilities:

  • Request system reports to facilitate resolution of assigned provider's claims issues.
  • Advise the senior claims staff of any irregularities in physician or provider billing procedures.
  • Work with the Director to develop and provide provider claims training.
  • Responsible for understanding and performing job responsibilities consistent with the company's mission statement, values statement, code of conduct and global goals.
  • Interface with TPA to facilitate and expedite claims payment including question resolution, benefit interpretation and authorization.
  • Schedule review meetings with providers to discuss issues or represent Claims at such meetings as requested by other departments.
  • Quality control functions including accuracy review and efficiency of the claims vendor's processing of claims and the development of action plans for problem resolution.
  • Ensure that batch integrity is maintained.
  • Provide weekly updates on all assigned providers to senior claims staff.
  • Must be able to travel to provider sites or regional offices
  • Develop spreadsheets to be sent to TPA to correct claims.
  • Follow-up on claims with Provider Relations Department including claims checks, technical questions, or adjustment requests.
  • Responsible for monitoring of assigned providers.
  • Screen, evaluate, edit and correct claims for service under HealthChoices Southwest program and determine eligibility for payment.

Qualifications

  • High school diploma or equivalent required plus 4 years claim form experience in a medical setting or medical billing experience.
  • Demonstrated analytical, oral, and organizational skills and sense of responsibility required.
  • PC proficiency in a windows environment for word processing and spreadsheet software.
  • Knowledge of behavioral health terminology, ICD/9 and Medicaid procedure coding.
  • Competency in typing required.


Licensure, Certifications, and Clearances:



UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct