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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Denials Management Specialist

  • Job ID: 222567114
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Pinnacle Health Support Services
  • Department: Patient Accounts
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $20.96 to $31.44 / hour

Description

Purpose:
Under the supervision of the Director of Patient Accounts, this position provides consultation and assistance to System department Directors and Managers on improving reimbursement. Collaborates with the Patient Accounts management team to identify areas of reimbursement improvement opportunity in support of the strategic goals of the department. Serves as a liaison between revenue cycle and clinical departments regarding revenue medical necessity payer requirements. Performs department assessments to identify improvement opportunities related to issues noted in the Epic work queues associated with coding/billing issues and CPT/HCPCS code applications. Develops and provides medical necessity related education to clinicians to facilitate the timely and accurate capture of reimbursement.

Responsibilities:

  • Performs other duties as assigned
  • The Denials Management Specialist position requires the ability to communicate with various levels of employees and present findings to the Director and Senior Management team. This position also requires the ability to understand issues that are operational or systemic in nature and quantify their relevance to the financial wellbeing of Pinnacle Health System. Individuals must be able to succeed in a busy and complex environment.
  • Prepares special projects as assigned by the Director of Patient Accounts
  • Researches rejections included in EOBs for resolution and files appropriately
  • Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts
  • Processes work lists to facilitate prompt intervention of insurance denials
  • Identifies and pursues opportunities for improvements in denial performance
  • Prioritizes activities to work overturns in a timely manner to alleviate untimely filings
  • Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement
  • Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials
  • Researches and analyzes denial data and coordinate denial recovery responsibilities.

Qualifications

  • High school diploma or equivalent certification
  • Demonstrated understanding of medical terminologyKnowledge of CPT/HCPCS and ICD10 codingKnowledge of medical billing and collection practices
  • Working knowledge with electronic medical records and healthcare IT systems
  • Excellent written and verbal skills, as well as, outstanding interpersonal skills
  • Detail oriented and work both independently and collaboratively with various administrative and clinical staff
  • Organized, sets priorities, and meets deadlines.  Ability to create reports for documentation of issues in Word and Excel spreadsheet formats.B.A. / B.S. preferred.
  • Process improvement and management analyses experience preferredExperience with Epic System preferred.Licensure, Certifications, and Clearances:
  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

COVID-19 Vaccination Information

Individuals hired into this role must comply with UPMC’s COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.

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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