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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

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Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

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

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Medical Assistance Revenue Analyst

  • Job ID: 789373109
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: 68740 HPLAN Medicaid Programs
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $29.18 to $49.16 / hour

Description

UPMC has an exciting opportunity for a Medical Assictance Revenue Analyst position in the Medicaid depaertment.  This will be a full time position working Monday through Friday daylight hours.  This will be a hybrid position working from home and in office which is located in the US Steel Tower in downtown Pittsburgh.

The Revenue Analyst will assist the Manager of Finance and Strategic Analysis with the day to day oversight responsibilities of providing responsive and timely financial reporting and strategic data analysis regarding risk adjusted revenue optimization strategies.

Responsibilities:

  • Effectively work with clinical, operational and financial staff to develop innovative ways to make quality information more transparent to consumers to actively use in their healthcare decision processes, clearly identifying how these strategies can improve risk revenue results.
  • Work collectively with analysts responsible for member incentive development to continually find innovative ways to encourage identified members to see providers in order to optimize risk adjustment revenue opportunities.
  • Work directly with the Director of Medical Assistance, Manager of Finance and Strategic Analysis, certain management in other functional areas of the Health Plan (such as Network, Clinical Coding, Provider Services, Member Services, Medical Management, etc.), analytical and operational staff to analyze and identify key opportunities for improving current risk adjustment revenue business practices and determining ways to effectively monitor results of strategic programs.
  • Assist the Manager of Finance and Strategic Analysis with conducting business in a professional manner with potential vendor relationships from a revenue perspective, and assist in establishing all budget expectations regarding risk adjusted revenue streams.
  • Integrate strategic predictive modeling methods to better understand the Medical Assistance population and efficient ways to manage and monitor their risk revenue opportunities.
  • Utilize SQL or SAS coding to extract data in a timely fashion to meet the needs of program development and management progress report requests.
  • Implement and manage methods to more aggressively isolate Pharmacy Third Party Liability (TPL) / Coordination of benefits (COB) opportunities.
  • Serve as principal Health Plan analyst and go-to person on the CDPS requirements of the Pennsylvania risk adjustment program.
  • Provide key information to senior management in a timely and comprehensive manner.
  • Collaborate with statutory management and analytical staff in the preparation of revenue and case mix studies, revenue and expenditure forecasting / statistical analysis, and other analysis and work to ensure business recommendations based on the outcomes of the analyses are effectively communicated to management and executive leadership.
  • Work proactively with reimbursement staff to analyze and potentially develop up-front reimbursement strategies linking procedure payment to ICD-10 requirements
  • Become actively involved in assessing the impacts ICD-10 diagnosis coding requirements will have on the risk adjustment revenue processes, and routinely report ongoing strategy development in this regard to management.
  • Collaborate with clinical and coding analysts to determine tier membership into manageable segments for focused outreach efforts, and then formally evaluate and present results.

 

Qualifications

  • Bachelor Degree from an accredited college or university in marketing, business, health administration, mathematics, statistics or a related field required.
  • Master Degree in business, mathematics, statistics, or health administration preferred.
  • Minimum of five years experience in Healthcare or business analysis or related required.
  • Verifiable experience with Medicaid and/or Medicare managed care is preferred.
  • Knowledge of Pennsylvania or other state revenue and risk adjustment Medicaid terminology (such as CDPS) preferred.
  • Independent decision-making skills required.
  • Knowledge of Microsoft Office and excel spreadsheet program preferred.
  • Knowledge of SQL or SAS programming preferred.
  • Advanced analytical and statistical skills necessary to evaluate business opportunities in a comprehensive manner.
  • Demonstrates good organizational skills.
  • Excellent interpersonal, written and verbal communication skills.
  • Flexibility in schedule required to meet business needs.
  • Ability to multi-task and handle the projects in a fast-paced professional environment necessary.
  • Detail oriented and ability to develop thorough action plans that can be communicated in a timely and effective manner as required.
  • Demonstrated performance in meeting deadlines, particularly in matrix business environments.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct