The coordinator plans and executes activities to enhance patient communication, improve flow, and remove barriers to timely care. They collaborate with leadership and various disciplines to develop educational literature and ensure an optimal patient experience.
UPMC
21 Remote Job Openings at UPMC
Serve as the first point of contact for prospective Medicare Advantage members by answering inbound calls and conducting outbound outreach. Educate callers on plan options, assist with enrollment, and document all interactions in the CRM system.
Perform utilization reviews and clinical assessments to ensure members receive cost-effective care in the most appropriate setting. Coordinate safe discharge transitions from inpatient settings by collaborating with providers, physicians, and medical directors.
Manage fiscal functions to ensure prompt payment from insurers and patients while resolving payment discrepancies and denials. Identify procedural deficiencies and serve as a mentor to staff for training and direction.
Assess patient needs over the phone to determine urgency and provide clinical advice based on established protocols. Coordinate follow-up care with physicians and insurers while accurately documenting all assessments.
Manage behavioral health and minor medical disability cases by coordinating leave processes and verifying eligibility. Collaborate with healthcare providers and employees to monitor treatment plans and facilitate return-to-work efforts.
Conduct clinical audits and reviews to identify fraud, waste, and abuse related to clinical guidelines and coding requirements. Collaborate with legal and medical management to resolve cases and provide reporting on auditing data and trends.
Assign accurate diagnosis and procedure codes for patients while monitoring pre-bill edit and error reports. Provide feedback and training to other coders and ensure timely billing through rigorous chart review.
Lead the development of actuarial and financial models to project the performance of medical cost improvement strategies and clinical programs. Analyze healthcare affordability initiatives and present actionable insights to senior leadership to drive corporate decision-making.
Responsible for assigning accurate ICD-10 and CPT codes for same-day surgery and observation cases to ensure proper reimbursement. Tasks include reviewing documentation for completeness, reconciling NCCI edits, and formulating physician queries for clarification.
Responsible for the investigation, evaluation, and disposition of Workers Compensation lost time claims for the WorkPartners business unit. This includes managing litigation activities, establishing reserves, and coordinating with medical experts and legal counsel.
Supervise a team of Hospital Billing claims analysts and provide technical guidance on claims and remittance administration. Coordinate regulatory updates, Epic upgrades, and collaborate with Professional Billing teams on shared system issues.
The specialist facilitates modifications to clinical documentation through interaction with physicians to ensure appropriate clinical severity is captured. They are responsible for the daily evaluation of medical records and presenting trended data to healthcare teams.
The Contact Center Navigator provides care coordination, health education, and clinical triage for members via telephonic and electronic communication. They are responsible for conducting initial health assessments and facilitating member enrollment in health services.
Maintain accurate physician data and imaging reports within the Radiology Information system to improve patient care. Perform audits, conduct statistical analysis, and act as a liaison between departments to acquire patient information and manage billing charges.
Review physician and nursing documentation to assign accurate ICD and CPT codes while maximizing reimbursement. Resolve coding denials and claim edits across various specialties to ensure optimal revenue cycle performance.
Oversees the delivery of high-quality healthcare and adherence to utilization standards for UPMC Health Plan members. Leads provider credentialing, quality improvement goals, and the review of medically pressing issues and member grievances.
Review physician and nursing documentation to assign accurate ICD and CPT codes for ENT services. Manage coding edits, denials, and physician queries to ensure optimal reimbursement and compliance.
The specialist is responsible for the investigation, evaluation, negotiation, and disposition of assigned workers' compensation lost time claims. They will also manage litigation activities, budgets, and claim outcomes while ensuring compliance with company policies and state regulations.
The Medical Physicist will oversee dosimetrists to ensure accurate treatment plans and collaborate with the Radiation Oncologist for treatment planning and delivery. Key duties include developing quality control programs, ensuring equipment functionality through precise measurements, and maintaining regulatory compliance.
The Lost Time Claims Specialist II is responsible for the analysis, investigation, evaluation, negotiation, and disposition of assigned claims. They will manage litigation activities and ensure claims are processed according to company policies and best practices.
