• Senior Payment Accuracy Analyst

    UPMC (Pittsburgh, PA)


    Are you passionate about ensuring accuracy and driving efficiency in healthcare reimbursement? At UPMC Health Plan, we're looking for a Senior Payment Accuracy Analyst to play a critical role in shaping how claims are processed and paid. This is your opportunity to make a real impact on payment integrity and compliance while collaborating with talented teams across the organization.

    What You'll Do:

    In this role, you'll be the go-to expert for payment accuracy and claim editing. You'll work closely with our external software vendor and internal teams to implement and maintain industry-standard clinical coding edits. Your insights will help us ensure compliance with Medicare, Medicaid, and other payor requirements while identifying opportunities for cost savings.

    Here's what your day-to-day will look like:

    + 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.

    What We're Looking For:

    + 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.

     

    This position is hybrid. There is an in-office requirement of at least once per month. Additional time in the office may be required based on business needs.

     

    + Bachelor's degree and 4 years of relevant experience OR equivalent combination of education & work within healthcare payers/claims payment processing will be considered

    + 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

    + 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 skillsLicensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran