Responsible for ensuring prompt and correct payment to the hospital from insurers and patients by managing claims, payments, and adjustments. The role involves identifying procedural deficiencies, resolving payment discrepancies, and mentoring staff on revenue cycle processes.
UPMC
23 Remote Job Openings at UPMC
Lead the analysis of financial and clinical data to identify variations and drive performance across UPMC Health Plan products. Develop episode-based methodologies to compare provider cost, efficiency, and quality while communicating insights to stakeholders.
Lead data analytics and visualization projects to support the system antimicrobial stewardship program. Develop departmental dashboards and produce professional deliverables for executive leadership to drive data-driven clinical insights.
Assess patient symptoms 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.
The Senior Cloud Engineer is responsible for driving cloud strategy, architecture, and automation across infrastructure and security domains. This includes designing scalable cloud environments, mentoring team members, and providing 24/7 production support.
Responsible for the investigation, evaluation, and disposition of lost time workers' compensation claims across several US jurisdictions. The role involves managing litigation activities, setting reserves, and coordinating with medical experts and legal counsel.
The Coder II is responsible for assigning and verifying accurate ICD-10-CM and PCS codes for inpatient accounts by reviewing electronic health records. They must ensure coding accuracy and completeness to facilitate proper reimbursement and adhere to official coding guidelines.
Contribute to the overall Software Development Life Cycle by developing, validating, and implementing software solutions. Responsibilities include writing quality unit-tested code, participating in peer reviews, and creating technical documentation.
Responsible for assigning ICD-10 and CPT codes for Outpatient Emergency Room accounts by reviewing physician reports and nursing documentation. Ensures accurate reimbursement by following ACEP guidelines and verifying medical necessity for ordered tests.
Responsible for reviewing clinical information and making authorization determinations for behavioral health and substance use disorder levels of care. The role also involves crisis management, triage assessments, and coordinating service plans between primary care and behavioral health providers.
Review physician and nursing documentation to assign accurate ICD and CPT codes to maximize reimbursement. Resolve coding denials and edits while maintaining productivity and accuracy standards.
Responsible for managing fiscal functions to ensure prompt payment from insurers and patients, including claims submission and denial resolution. Acts as a senior mentor to staff and identifies procedural deficiencies to improve the revenue cycle.
The Medical Director oversees utilization management and quality standards to ensure high-quality healthcare delivery for health plan members. This includes leading provider credentialing, conducting medical reviews, and managing relationships between the network and healthcare providers.
Responsible for the investigation, evaluation, and disposition of lost time Workers' Compensation claims in Florida and Georgia. This includes managing litigation budgets, establishing reserves, and coordinating with medical experts and legal counsel.
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.
The Managing Actuary will partner with senior leadership to develop medical cost improvement strategies and direct a team to produce detailed actuarial and financial models. This role involves forecasting financial results of value-based contracts and developing healthcare claims cost trends.
Review physician and nursing documentation to assign accurate ICD and CPT codes while maximizing reimbursement. Monitor and resolve coding edits and denials to ensure optimal billing accuracy and efficiency.
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.
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.
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.
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 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.
