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   Current UPMC employees must apply in HR Direct

Retrospective Appeals Coder

  • Job ID: 2100045L
  • 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: $29.66 to $45.96 / hour


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.


  • 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.



  • 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

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   Current UPMC employees must apply in HR Direct