UPMC

Role Description UPMC Corporate Revenue Cycle is hiring a Coder I, Technical, to join our Same Day Surgery Coding team! This position will be a work-from-home position working Monday through Friday during business hours. In this role you will code same-day surgery accounts, CPT procedures, and diagnosis coding. This role requires ICD-10 diagnosis coding skills, as well as knowledge of billing and coding guidelines. - Review the physician script, order or chief complaint as documented in a diagnostic report to determine the appropriate ICD-10 code. - Ensure diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered. Responsibilities: - Refer problem accounts to appropriate coding or management personnel for resolution. - Meet appropriate coding productivity and quality standards within the time frame established by management staff. - Adhere to internal department policies and procedures to ensure efficient work processes. - Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. - Maintain continuing education by attending seminars, reviewing updated CPT assistant guidelines and updated coding clinics. - Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. - Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-9-CM/ICD-10-CM, CPT and DSM IV codes for outpatient records to ensure accurate reimbursement. - Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care are sequenced in order of their clinical significance to accurately assign the appropriate APC/ASC or payment tier under the Prospective Payment system or DSM IV methodology to guarantee accurate reimbursement on UPMC patients. - Utilize computer applications and resources essential to completing the coding process efficiently, such as hospital information systems, EHR information systems, encoders and electronic medical record repositories. - If applicable, abstract required medical and demographic information from the medical record and enter the data into the appropriate information system to ensure accuracy of the database. - Complete work assignments in a timely manner and understand the workflow of the department including routing cases appropriately in the electronic systems. - Code by assigning and verifying the principle and secondary diagnoses (ICD-9-CM/ICD-10-CM) and procedures (CPT codes or DSM, IV if applicable) by thoroughly reviewing all documentation available at the time of coding. - Complete a non coding time productivity sheet as required/applicable. Qualifications - High School or GED equivalent. - Completed an AHIMA or AACP-certified Coding program or certificate, Bidwell Training School or equivalent program with a curriculum that includes Anatomy and Physiology, Medical Terminology, ICD-9-CM/ICD 10 and CPT Coding Guidelines and Procedures. - Six months hospitals coding experience preferred. Licensure, Certifications, and Clearances - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description UPMC Corporate Revenue Cycle is hiring a Coder II to join our Coding Department! This position will be a work-from-home position working Monday through Friday during business hours. In this role, you will be handling same-day surgery and observation coding: - Coding diagnosis & procedure codes ICD10 & CPT codes - Charging for injections, infusions, hydrations - Reconciling NCCI edits Responsibilities: - Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. - Utilize standard coding guidelines, principles, and coding clinics to assign appropriate ICD-10-CM, CPT, and DSM IV codes for all record types to ensure accurate reimbursement. - Utilize the ACEP acuity level guidelines for assigning the correct acuity level for ED coding or hospital specific acuity level module as needed. - Adhere to internal department policies and procedures to ensure efficient work processes. - Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. - Maintain continuing education by attending seminars, reviewing updated CPT assistant guidelines and updated coding clinics. - Make forward progress within the training period toward meeting coding accuracy standards of 98% within the first year of employment. - Meet appropriate coding productivity standards within the time frame established by management staff. - Code all diagnoses and procedures by assigning and verifying the proper ICD-10-CM and CPT codes (DSM IV if applicable). - Assign the principal and secondary diagnoses and procedures by thoroughly reviewing all documentation available at the time of coding. - Utilize computer applications and resources essential to completing the coding process efficiently, such as hospital information systems (Medipac/SMS/Meditech), encoders, and electronic medical record repositories. - If applicable, abstract required medical and demographic information from the medical record and enter the data into the appropriate information system to ensure accuracy of the database. - Correct any data to be in error after reviewing the medical record and comparing with system entries. - Refer problem accounts to appropriate coding or management personnel for resolution. - Complete work assignments in a timely manner and understand the workflow of the department. - Maintain daily productivity statistics and submit a weekly productivity sheet to management clearly indicating the number of hours worked, the number of coding hours, the number of average charts per hour, and number of minutes/hours spent on non-coding tasks. - Determine diagnoses that were treated, monitored, and evaluated and procedures done during the episode of care and assign appropriate codes. - Review appropriate documents in the patients' charts to accurately assign a diagnosis and/or procedure. - Ensure the diagnoses and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG/APC/ASC or payment tier under the Prospective Payment system or DSM IV methodology to guarantee accurate reimbursement on UPMC patients. - Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the coding process. - Consult with DRG Specialist when applicable during query process. Qualifications - High School or GED equivalent. - Two years of hospital coding experience. - Completed an AHIMA or AACP-certified Coding program or certificate, Bidwell Training School or equivalent program with a curriculum that includes Anatomy and Physiology, Pharmacology, Pathophysiology, Medical Terminology, ICD-10-CM and CPT Coding Guidelines and Procedures. - Outpatient: pharmacology is taught on the job during training; pathophysiology not required. - Inpatient: Pharmacology & pathophysiology coursework required. Requirements - Eligible for RHIA, RHIT, CCS - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description Do you take pride in delivering high-quality customer service and creating positive first impressions? If you enjoy helping others, answering questions, and guiding people toward the right solutions, this opportunity could be a great fit for you. As part of our team, you’ll work from the comfort of your home while serving as a trusted first point of contact for individuals exploring UPMC For Life Medicare Advantage plans. Every conversation you have has the potential to make a meaningful impact. What You’ll Do - Be the friendly voice that answers inbound calls and helps prospective members navigate their options - Educate callers about UPMC For Life and guide them toward the right resources - Support our Sales team by conducting outbound outreach (no cold calling) to prospective members - Assist individuals with enrolling in plans—right over the phone - Accurately document interactions and manage lead information in our CRM system - Contribute to additional data entry and support projects What Your Schedule Looks Like - Variable 8-hour shifts between 8:00 AM – 8:00 PM - Includes evenings and weekends as needed Why This Opportunity Stands Out - 100% remote - Competitive pay at $19/hour - Temporary role (up to 6 months) - A great way to get your foot in the door with a respected healthcare organization Qualifications - A passion for helping others and delivering excellent customer service - Strong communication skills and comfort speaking on the phone throughout the day - Ability to learn and explain Medicare and Special Needs Plan information - Comfort navigating multiple systems while multitasking (listening, typing, researching) - Attention to detail when documenting information Requirements - Internet speeds of 20 Mbps download / 5 Mbps upload or greater - Under 50ms ping and under 10ms jitter - Please note: Satellite, hotspot/cellular, or DSL services are not supported - High School graduate or equivalent preferred - Proficiency in typing, Windows Systems, and MS Office products - PA Accident and Health insurance is a plus - Ability to make independent decisions - Minimum 6 months of direct customer service experience; call center, specifically retail and food service industry experience, preferred - Basic analytical skills necessary to evaluate customer needs - Exemplary Customer service skills and professionalism in adherence to UPMC-based values - Knowledge of Medicare or Insurance Terminology is a plus - Licensure, Certifications, and Clearances: Act 34 Criminal Clearance or Act 34 Criminal Clearance with Renewal Company Description

Role Description Are you an experienced nurse with a background in case management? Are you interested in the opportunity to work from home? UPMC Health Plan is looking for you! We are hiring a full-time Telephonic Care Manager to support the Special Needs Plan team. This position will be predominantly working from home and will work standard EST daylight hours, Monday through Friday. Preference will be given to candidates with a Pennsylvania or Compact RN license. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. Responsibilities include: - Identifying members' medical, behavioral, and social needs and barriers to care. - Developing a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member's self-management of chronic illness based on clinical standards of care. - Collaborating and facilitating care with other medical management staff, other departments, providers, community resources, and caregivers to provide additional support. - Following members by telephone or other electronic communication methods. Qualifications - Minimum of 2 years of experience in a clinical setting and case management nursing required. - A minimum of 5 years nursing experience is highly preferred. - BSN preferred. - Ability to interact with physicians and other health care professionals in a professional manner required. - Excellent verbal and written communication and interpersonal skills required. - Computer proficiency required. - Meet minimum internet system/service and speed/latency requirements as set forth by UPMC. - Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Requirements - Case management certification or approved clinical certification preferred. - Registered Nurse (RN). - Act 34 clearance. - Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. - Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description The Medicare Sales Support Representative provides administrative, operational, and customer support for the Medicare Sales team at UPMC Health Plan. This remote position is responsible for assisting sales representatives, brokers, and prospective members by handling inquiries, processing documentation, maintaining accurate records, and supporting day-to-day sales operations to ensure a positive customer experience and compliance with Medicare regulations. This is a Monday through Friday daylight position; however, occasional evening shifts may be required to support business needs. The Sales Rep will assist in managing membership growth and retention through the service area via telephonic contact with prospective members. Support the department's sales processes including answering incoming inquiries from prospective UPMC members and assisting with enrollments. Provide critical first impression to callers and help navigate them towards one of the ways to learn. - Conduct outbound calls in accordance with sales department initiatives. - Provide exemplary customer service by being proactive and responsive to all prospective UPMC Health Plan customer requests. - Ability to understand and effectively communicate information regarding Medicare and Special Needs Plan product line. - Leverage multiple department applications and systems while speaking to prospective members. - Remain current on all department policies, procedures, plan benefit designs, and marketing activities resulting in Telephonic contact. - Answer incoming inquiries from prospective UPMC Health Plan customers to support department sales goals. - Document inquiries in sales CRM system in accordance with department guidelines. Qualifications - High school graduate or equivalent required. - College degree preferred. - Proficiency in typing. - Ability to make independent decisions required. - Knowledge of Microsoft Office and Excel Spreadsheet program preferred. - Basic analytical skills necessary to evaluate customer needs. - Demonstrates good organizational skills. - Minimum of 6 months of customer service and/or call center experience. Requirements - Licensure, Certifications, and Clearances: Act 34. Benefits - UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description UPMC Corporate Revenue Cycle is hiring a Coder I, Technical, to join our Same Day Surgery Coding team! This position will be a work-from-home position working Monday through Friday during business hours. In this role you will code same-day surgery accounts, CPT procedures, and diagnosis coding. This role requires ICD-10 diagnosis coding skills, as well as knowledge of billing and coding guidelines. - Refer problem accounts to appropriate coding or management personnel for resolution. - Meet appropriate coding productivity and quality standards within the time frame established by management staff. - Adhere to internal department policies and procedures to ensure efficient work processes. - Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. - Maintain continuing education by attending seminars, reviewing updated CPT assistant guidelines and updated coding clinics. - Review coding for accuracy and completeness prior to submission to the billing system, utilizing CCI edits. - Utilize standard coding guidelines and principles, and coding clinics to assign the appropriate ICD-10-CM and CPT codes for outpatient records to ensure accurate reimbursement. - Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care are sequenced in order of their clinical significance to accurately assign the appropriate APC/ASC or payment tier under the Prospective Payment system or DSM IV methodology to guarantee accurate reimbursement on UPMC patients. - Utilize computer applications and resources essential to completing the coding process efficiently, such as hospital information systems, EHR information systems, encoders and electronic medical record repositories. - If applicable, abstract required medical and demographic information from the medical record and enter the data into the appropriate information system to ensure accuracy of the database. - Complete work assignments in a timely manner and understand the workflow of the department including routing cases appropriately in the electronic systems. - Code by assigning and verifying the principle and secondary diagnoses (ICD-10-CM) and procedures (CPT codes or DSM, IV if applicable) by thoroughly reviewing all documentation available at the time of coding. - Complete a non-coding time productivity sheet as required/applicable. Qualifications - High School or GED equivalent. - Completed an AHIMA or AACP-certified Coding program or certificate, Bidwell Training School or equivalent program with a curriculum that includes Anatomy and Physiology, Medical Terminology, ICD-9-CM/ICD 10 and CPT Coding Guidelines and Procedures. - Six months of hospital coding experience preferred. Licensure, Certifications, and Clearances - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description UPMC Corporate Revenue Cycle is hiring a Coder I- Profee to join our Coding Department! This position will be a work-from-home position working Monday through Friday during business hours. This position will be working on Professional (Physician) Coding Denials. We are looking for Coders who have denials experience. In this role, you will: - Assign ICD and limited CPT codes. - Review the physician documentation to determine the appropriate ICD-10 code and primarily verify the CPT code. - Resolve basic coding edits, complete charge processing, and ensure diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered. - Utilize coding resources (CCI edits, 3M, ICD and CPT Publications) along with any other applicable specialty reference material to ensure accurate coding. Responsibilities: - Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD and CPT for all records to ensure accurate reimbursement. - Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits. - Complete work assignments in a timely manner and understand the workflow of the department. - Maintain daily productivity statistics and submit a weekly productivity sheet to management. - Identify incomplete documentation in the medical record and formulate a physician query to obtain missing documentation and/or clarification to accurately complete the coding process. - Utilize computer applications and resources essential to completing the coding process and to resolve basic coding edits efficiently. - Refer problem accounts to appropriate coding or management personnel for resolution. - Meet and maintain charge lag and coding productivity standards within the time frame established by management staff. - Adhere to internal and system-wide competencies, behaviors, policies and procedures to ensure efficient work processes. - Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements. - Maintain continuing education by reviewing updated CPT assistant guidelines and updated coding clinics. - Make forward progress within the training period toward meeting coding accuracy standards of the departments within the first year of employment. - Meet appropriate coding productivity standards within the time frame established by management. Qualifications - High school graduate or equivalent. - In lieu of completed coding externship, 6 months experience. - Graduate of an approved certified coding program preferred with a curriculum that includes Anatomy and Physiology, Medical Terminology, ICD-9-CM/ICD-10 and CPT Coding Guidelines and Procedures. - Proficient computer skills with MS Excel knowledge preferred. Requirements - Licensure, Certifications, and Clearances: Act 34. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. The Leave Specialist provides administrative and transactional support services for employees' leave of absence requests. - Advises employees, employee's family members, managers, and HR Professionals on leave policies and processes. - Tracks employee absences as reported via web, fax, phone, and e-mail. - Responsible for resolving issues by interacting with employee's manager, Human Resources, payroll, or disability specialists. - Coordinates the leave process; verifies eligibility, determines leave approval, calculates leave length, and monitors maximum duration of leave allowed under federal/state and/or client policy. - Supports in-bound and outbound employee leave related calls. - Applies concepts and rules as mandated by guidelines for FMLA and other federally or state mandated or company specific leaves. - Responsible for all communications with the employee, the employee's manager, Human Resources, and all integrated partners throughout the duration of the leave. - Utilizes HR information system [Peoplesoft], payroll system [Kronos], and web-based vendor software as needed to input and update leave data and generate reports. - Assists in the identification of recommendations to positively impact the efficiency and quality of service delivery. Qualifications - Bachelor's degree and 1 year of leave of absence processing or Human Resources experience, OR High School and 3 years of leave of absence processing or Human Resources experience. - Minimum of 1 year of Absence processing required. - Ability to use and navigate web-based software programs and Microsoft Office products [Outlook, Word, Excel etc]. - Ability to communicate effectively both verbally and in writing. - Knowledge of client leave policies, federal and state leave laws pertaining to leave of absence. Requirements - Certified Leave Management Specialist (CLMS) designation required within 12 months of hire. - To maintain designation, 20 hours of continuing education credits are required every two years. Benefits - This position is work-from-home anywhere in the Continental US. - Despite the pay range listed, the current budget for this position is $25.40 - $27/hr. - In the event that there is a high volume of applications received, we will only be able to consider the first 100 applications.

Role Description UPMC Health Plan has an exciting opportunity for a Member Complaints & Grievances Coordinator, I position in the Member CGA department. This is a full-time position working Monday through Friday daylight hours and is a remote position. The C&G Coordinator I will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files. - Conduct case intake process for statements received through verbal and written requests and set up new cases in the C&G information system. - Classify member complaints/appeals based on line of business/product according to department and regulatory standards and appeal rights. - Complete appropriate investigation which may include investigation of previous appeals, claims, authorizations, and inbound calls. - Have a general understanding for the different appeal rights associated with each line of business. - Ensure prompt response to all follow-up needs on every case for compliance needs and member satisfaction. - Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines. - Organize all tasks within regulatory requirements/deadlines. - Access and navigate multiple health plan systems to support accurate case classification. - Utilize PA Keystone State resources to properly review and process member Fair Hearing documentation. - Accurately and promptly assess, enter, and maintain documents in files and/or databases. - Respond and address incoming messages via department FileNet folders, emails, fax system, or phone CUTs. - Triage and respond to inquiries as appropriate or note and distribute as needed. - Retrieve, copy, collate, and file various documents associated with the complaints and grievances processes. - Identify and escalate priority and expedited issues to all product leadership in a timely manner. - Support the team's efforts to improve performance against measured service operation goals. - Complete data entry into various information systems to support C&G processes. - Enter coverage determinations into systems of record. - Adapt quickly to system outages and issues by identifying effective workarounds and maintaining operational continuity. - Support implementation of appeals tracking system. Qualifications - High school graduate or equivalent required. - Two years of work experience in claims or customer service required. - Five years of managed care or health insurance experience preferred. - Proficiency in typing required. - Excellent communication, organizational, and customer service skills. - Detail-oriented, knowledge with Microsoft Word and Excel. - Demonstrate a positive and professional attitude. - Problem solving and decision-making skills with a solid understanding of managed care principles. - Knowledge of all product lines and ability to follow decision tools to assist with appropriate classification of all product lines and regulatory rules. - Critical thinking skills are crucial, as every case and investigation needs may vary, depending on member statements and other investigation findings. - Ability to remain flexible and responsive as requirements and case-handling expectations change regularly. Licensure, Certifications, and Clearances - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Role Description UPMC Health Plan is hiring a full-time Member C&G Coordinator I in the Member C&G department. This position works Monday through Friday, daylight hours and will be a remote position. The Member C&G Coordinator, I will track, trend, and manage member complaints and grievances for all product lines. Ensure the efficient and effective resolution of member complaints and grievances. Use the data collection and analysis to target initiatives for opportunities for improvement within the Health Plan. - Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standards. - Effectively utilize key internal and external Health Plan contacts, including Health Plan staff, providers, and external review organizations, to help in this process. - Organize all tasks within regulatory requirements/deadlines. - Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines. - Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan. - Coordinate and facilitate review hearings and internal appeal committee meetings or prepare Independent Review Entity case files dependent online of Business. - Assist in reporting complaint and grievance data to appropriate regulatory bodies and internal departments. - Support implementation of appeals tracking system. Qualifications - Associate degree or equivalent professional work experience. - 1 year of experience in health care environment required. - Medical claims and/or customer service background preferred. - Demonstrated success problem solving and decision making with a solid understanding of managed care principles. - Excellent verbal and written presentation skills are essential. - PC literacy with proficiency in the use of Microsoft office products. - Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology. Licensure, Certifications, and Clearances - Act 34 Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran