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 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.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

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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   Current UPMC employees must apply in HR Direct

Provider Reimbursement Adjustment Coordinator

  • Job ID: 709423674
  • 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: $18.78 to $31.22 / hour

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

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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