Reimbursement Analyst

at  UPMC

UPMC Health Plan is hiring a full-time Reimbursement Analyst to support the Hospital Reimbursement department. This role will work Monday through Friday standard daylight hours. The team is currently utilizing a hybrid work model. Most work is currently done remotely, but some days are spent in the office in downtown Pittsburgh’s US Steel Tower.
The Reimbursement Analyst is a mid-level analytical position responsible for all aspects of provider reimbursement. This includes establishing and maintaining compensation rates for hospitals, physicians, and ancillary services. Knowledge of fee schedules, case rates, per-diems, PDPM, as well as any other reimbursement methodology is preferred.

• Work with reimbursement specialist to develop/negotiate reimbursement rates for new providers. Including accurate, easy-to-understand analysis of the negotiated rates. Monitor and review new pricing configuration to assure the provider is pricing accurately as contracted. This includes maintaining documentation of your review. Resolve reimbursement issues.
• Update and maintain hospital reimbursement rate summary. Act as company expert on all reimbursement issues. Complete special projects accurately and timely. Out-of-network negotiations when required.
• Monitor Calendar to assure all action items are completed proactively. Update and maintain hospital reimbursement reports for all product lines. Reports include inpatient base rate comparisons, outpatient reimbursement comparisons to UPMC OP fee schedule, and Observation cost per case. Resolve problems that result in claims pending.
• Work with configuration staff when negotiating to assure negotiated rates are operational. Analyze and compare fee schedules. Attend meetings when required. Analyze all reimbursement, including outliers, transfer adjustments, etc.
• Bachelor’s Degree in health care administration, business and/or other related discipline (Related experience in a health care administration setting may be substituted for educational requirements).
• Prior claims and/or analytical experience preferred.
• Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.
• Advanced mathematical skills.
• Ability to interpret and summarize results of various analysis in a timely and meaningful way.
• Strong computer skills, including expert knowledge of Access and Excel.
• Experience with a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is preferred.
• Preferred individual needs to have in depth understanding of managed care delivery systems and have had direct experience with reimbursement.
• Knowledge of ICD-9CM, CPT4, Revenue Codes, DRGs, base rates, Medicare methodologies, Medicaid methodologies, HCPCS coding and related governmental guidelines and provider reimbursement methodologies preferred.
• Ability to work cooperatively with multidisciplinary teams and/or independently.
• Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.LICENSURE, CERTIFICATIONS, AND CLEARANCES:UPMC is an Equal Opportunity Employer/Disability/Veteran