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UPMC Community Care Behavioral Health is hiring a full-time Provider Reimbursement Adjustment Coordinator to support the Provider Reimbursement team. Upon completion of the in-person training period, this role may work predominantly remotely. This role will work Monday - Friday daylight hours.

_This is a phone-based role so candidates must be comfortable spending the majority of the day on the phone._

Under the direction of the Claims Director of Community Care, the incumbent will be responsible for overseeing the processing of all claims by the claims processing vendor.

Responsibilities:

+ Request system reports to facilitate resolution of assigned provider's claims issues.

+ Advise the senior claims staff of any irregularities in physician or provider billing procedures.

+ Work with the Director to develop and provide provider claims training.

+ Responsible for understanding and performing job responsibilities consistent with the company's mission statement, values statement, code of conduct and global goals.

+ Interface with TPA to facilitate and expedite claims payment including question resolution, benefit interpretation and authorization.

+ Schedule review meetings with providers to discuss issues or represent Claims at such meetings as requested by other departments.

+ Quality control functions including accuracy review and efficiency of the claims vendor's processing of claims and the development of action plans for problem resolution.

+ Ensure that batch integrity is maintained.

+ Provide weekly updates on all assigned providers to senior claims staff.

+ Must be able to travel to provider sites or regional offices

+ Develop spreadsheets to be sent to TPA to correct claims.

+ Follow-up on claims with Provider Relations Department including claims checks, technical questions, or adjustment requests.

+ Responsible for monitoring of assigned providers.

+ Screen, evaluate, edit and correct claims for service under HealthChoices Southwest program and determine eligibility for payment.

+ High school diploma or equivalent required plus 4 years claim form experience in a medical setting or medical billing experience.

+ Demonstrated analytical, oral, and organizational skills and sense of responsibility required.

+ PC proficiency in a windows environment for word processing and spreadsheet software.

+ Knowledge of behavioral health terminology, ICD/9 and Medicaid procedure coding.

+ Competency in typing required. **Licensure, Certifications, and Clearances:**

+ Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran