COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

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

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   Current UPMC employees must apply in HR Direct

Compliance Auditor, Senior I

  • Job ID: 629503098
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Finance
  • Department: Corporate Compliance
  • Location: 3600 Forbes Ave, Pittsburgh PA 15213
  • Union Position: No
  • Salary Range: $24.78 to $42.84 / hour

Description

At UPMC, we’re all here for the same reason — to make Life Changing Medicine happen. Join our team and you will play a unique and important role in our mission to change healthcare for the better. 

Why Join UPMC? 

We don’t just take care of patients — we take care of our team, too. And we have the data to prove it. In addition to the benefits you’d expect from an industry leader you can expect: 

  • AWARD-WINNING WORKPLACE: Ranked #1 for Best Places to Work for Women & Diverse Managers and 2020 Corporate Equality Index. 
  • A recent study showed that UPMC benefits are 20% higher in value than other healthcare providers in our market. 
  • Competitive pay 
  • Tuition reimbursement 
  • Opportunities to grow in your career at UPMC 

UPMC is hiring immediately a Compliance Auditor, Senior I role!  This opportunity is based at Forbes tower with possible work from home available after training is complete.  

Responsibilities:

  • Conduct UPMC wide auditing and monitoring to ensure coding/documentation combinations and medical record documentation adequately supports services coded and billed in accordance with the appropriate state and federal regulations and/or standards.
  • Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCS DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting.
  • Conduct audits on other compliance related topics as determined to evaluate compliance with the state and federal laws, regulations and policy
  • Develop concise and well referenced audit workpapers.
  • Communicate to key stakeholders regarding audit findings and corrective actions.
  • Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.
  • Advise leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines and related regulations.
  • Maintain current knowledge and understanding of regulatory trends and changes in coding policy and reimbursement methods.
  • Conduct post-audit compliance training sessions for physicians and non-physician practitioners as audit results dictate. These training sessions will include, but are not limited to, provision of education specific to the issues found on audit and will be largely based on the documentation, coding and billing rules as set forth by CMS and other relevant Federal and State regulatory agencies.

 

Qualifications

  • Associates Degree or higher or comparable technical school diploma is required.
  • Four or more years of experience in medical coding, billing, auditing and compliance.
  • Extensive knowledge of CMS, and third-party payer coding, billing, and documentation compliance regulations required (MS-DRG, APR-DRG, APC, APG, or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
  • Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes.
  • Experience in an academic medical center setting is strongly preferred.
  • Knowledge of key revenue cycle processes, and clinical documentation is strongly preferred.
  • Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is required.
  • Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.
  • Data Analytics experience is strongly preferred.


Licensure, Certifications, and Clearances:

  • Certified Coding Specialist (CCS)Certified Inpatient Coder (CIC) Certified Evaluation & Management Coder (CEMC)Certified Professional Medical Auditor (CPMA)Certified Professional Coder (CPC)Certified Medical Coder (CMC)ORRegistered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)ORLicensed Professional Nurse (LPN)Registered Nurse (RN)



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