Reimbursement Analyst

Purpose:
The UPMC Health Plan is seeking a Reimbursement Analyst to fill an opening in our Hospital Reimbursement department. This role offers a flexible work arrangement and is required to be in office in downtown Pittsburgh 3 days per week; however; the remaining days can be worked remotely.

The Reimbursement Analyst is a middle 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 required.
 

This role is Hybrid and will require 3 days onsite in Downtown Pittsburgh

Responsibilities:
 

• Work with Reimbursement Specialist in developing / negotiating 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, 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).
• 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-10CM, 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.
  
  
  UPMC is an Equal Opportunity Employer/Disability/Veteran

Job Details
Primary Location: USA-PA-Pittsburgh
Work Locations: US Steel Tower, 600 Grant St, 15219
Business Unit: UPMC Health Plan
Schedule: Regular, Full-Time
Shift: Day Job
Union: No
Salary Range: 21.14, 35.13