Description

UPMC has an exciting opportunity for a Provider Reimbursent Adjustment Coordinator. With Monday through Friday daylight hours and a hybrid work environment, don't miss your chance to join this established team.

Under the direction of the Claims Director of Community Care, the incumbent 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

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.