Provider Reimbursement Adjustment Coordinator - Pittsburgh

UPMC; Pittsburgh (Allegheny County); Remote; USD 40,000 - 65,000; Full time

Job summary

An established industry player is seeking a dedicated Provider Reimbursement Adjustment Coordinator to join their team in Pittsburgh. This full-time position offers a blend of in-person training and remote work flexibility. The ideal candidate will possess strong analytical and communication skills, along with a solid background in claim processing and medical billing. Responsibilities include overseeing claims processing, resolving provider claims issues, and ensuring compliance with policies. This role is perfect for those looking to make a significant impact in the healthcare sector while enjoying a supportive work environment.

Qualifications

• 4+ years of claim processing or medical billing experience in healthcare.
• Strong analytical and communication skills required.

Responsibilities

• Request system reports to resolve provider claims issues.
• Advise senior claims staff on billing irregularities.
• Conduct quality control on claims processing.

Skills

Analytical Skills

Organizational Skills

Communication Skills

Typing Proficiency

Education

High School Diploma or Equivalent

Tools

Windows-based Word Processing

Spreadsheets

Job description

Provider Reimbursement Adjustment Coordinator - Pittsburgh

Join to apply for the Provider Reimbursement Adjustment Coordinator - Pittsburgh role at UPMC.

UPMC Community Care Behavioral Health is hiring a full-time Provider Reimbursement Adjustment Coordinator to support the Provider Reimbursement team. After completing the in-person training, the role may be predominantly remote. The work hours are Monday - Friday during daylight hours.

This is a phone-based role, so candidates must be comfortable spending most of the day on the phone.

Under the direction of the Claims Director of Community Care, the incumbent will oversee the processing of all claims by the claims processing vendor.

Responsibilities:

1. Request system reports to facilitate resolution of provider claims issues.
2. Advise senior claims staff of irregularities in billing procedures.
3. Assist in developing and providing provider claims training.
4. Perform responsibilities aligned with the company's mission, values, code of conduct, and goals.
5. Interface with TPA to facilitate claims payment, question resolution, benefit interpretation, and authorization.
6. Schedule and participate in review meetings with providers.
7. Conduct quality control on claims processing and develop action plans for issues.
8. Maintain batch integrity.
9. Provide weekly updates on providers to senior claims staff.
10. Travel to provider sites or regional offices as needed.
11. Create spreadsheets for claim corrections sent to TPA.
12. Follow-up with Provider Relations for claims checks, questions, or adjustments.
13. Monitor assigned providers.
14. Screen, evaluate, edit, and correct claims under the HealthChoices Southwest program, determining payment eligibility.
15. Ensure compliance with all relevant policies and procedures.

Minimum Qualifications:

• High school diploma or equivalent.
• At least 4 years of claim processing or medical billing experience in a healthcare setting.
• Strong analytical, organizational, and communication skills.
• Proficiency in Windows-based word processing and spreadsheets.
• Knowledge of behavioral health terminology, ICD/9 coding, and Medicaid procedures.
• Typing proficiency.

Licensure, Certifications, and Clearances:

• Act 34 clearance.

UPMC is an Equal Opportunity Employer/Disability/Veteran.