UPMC · 12 hours ago
Senior Payment Accuracy Analyst
Pittsburgh, PA
Full-time
Hybrid
Mid, Senior Level
4+ years expUPMC is a healthcare organization seeking a Senior Payment Accuracy Analyst to enhance accuracy and efficiency in healthcare reimbursement. The role involves collaborating with teams to implement clinical coding edits, ensuring compliance with payor requirements, and driving initiatives for cost savings.
BiotechnologyHealth CareHospitalMedical
Responsibilities
Turn data into decisions: Use your expertise in SQL and BI tools like Power BI and Tableau to create dashboards and actionable insights
Collaborate across teams: Partner with Claims Operations, Medical Policy, IT, and more to align edits with clinical and financial goals
Lead impactful projects: Drive initiatives that monitor and adapt to changes in payment and medical policy
Be the subject matter expert: Advise leadership on coding and policy changes, ensuring edits work as intended and meet compliance standards
Stay ahead of the curve: Keep up with industry trends, regulatory updates, and evolving payment models
Qualification
Required
Strong skills in data reporting and visualization (SQL, Power BI, Tableau)
Deep knowledge of coding standards and claim editing (AMA, CMS, NCCI)
Ability to analyze complex data, identify root causes, and recommend solutions
Excellent communication skills to work with leadership and cross-functional teams
A proactive mindset to lead projects and drive continuous improvement
Bachelor's degree and 4 years of relevant experience OR equivalent combination of education & work within healthcare payers/claims payment processing will be considered
Ability to interpret claim edit rules and references
Solid understanding of claims workflow and the ability to interpret professional and facility claim forms
Ability to apply industry coding guidelines to claim processes
Ability to perform audits of claims processes and apply root-cause
Significant experience with Excel for data analysis and creating reports for senior management
Familiarity with relational databases, such as Microsoft Access, SQL, etc
Excellent verbal & written communication skills
Preferred
Previous experience with SQL, Power BI and or Tableau highly preferred
Current certified coder (CCS, CCS-P or CPC), or Registered Health Information Technician (RHIA/RHIT) preferred, but not required
Company
UPMC
UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.46MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.46M
Leadership Team
Leslie Davis
President and CEO
Frederick M. Hargett
Chief Financial Officer
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