Reimbursement Analyst Location: Pittsburgh, PA, United States Job ID: 7698335898 Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Hybrid Facility: UPMC Health Plan Department: Hospital Reimbursement Union Position: No Salary Range: $ 21.14-35.13 USD Job Description: Purpose: The UPMC Health Plan is hiring a full-time Reimbursement Analyst to support the Hospital Reimbursement department. The Reimbursement Analyst is a middle level analytical position responsible for all aspects of provider reimbursement. This includes establishing and maintaining compensation rates for hospitals, physicians, and ancillary services. Knowledge of fee schedules, case rates, per-diems, RUG III, as well as any other reimbursement methodology is required. This role is Hybrid and will require 3 days onsite Responsibilities: - Work with Reimbursement Specialist in developing / negotiating reimbursement rates for new providers. Including accurate, easy to understand analysis of the negotiated rates. - Monitor and review new pricing configuration to assure the provider is pricing accurately as contracted. This includes maintaining documentation of your review. - Resolve reimbursement issues. - Update and maintain hospital reimbursement rate summary. - Act as company expert on all reimbursement issues. - Complete special projects accurately and timely. - Out of network negotiations when required. - Monitor Calendar to assure all action items are completed proactively. - Update and maintain hospital reimbursement reports for all product lines. Reports include inpatient base rate comparisons, outpatient reimbursement comparisons to UPMC OP fee schedule, Observation cost per case. - Resolve problems that result in claims pending. - Work with configuration staff when negotiating to assure negotiated rates are operational. Analyze and compare fee schedules. - Attend meetings when required. - Analyze all reimbursement, including outliers, transfer adjustments, etc. Qualifications: - Bachelor's Degree in health care administration, business and/or other related discipline (Related experience in a health care administration setting may be substituted for educational requirements). - Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities. - Advanced mathematical skills. - Ability to interpret and summarize results of various analysis in a timely and meaningful way. - Strong computer skills, including expert knowledge of Access and Excel. - Experience with a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is preferred. - Preferred individual will have in depth understanding of managed care delivery systems and have had direct experience with reimbursement. - Knowledge of ICD-9CM, CPT4, Revenue Codes, DRGs, base rates, Medicare methodologies, Medicaid methodologies, HCPCS coding and related governmental guidelines and provider reimbursement methodologies preferred. - Ability to work cooperatively with multidisciplinary teams and/or independently. - Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.

• Create and implement tactics and strategies that enhance speech-language pathologists’ confidence and efficiency in completing insurance-required speech evaluations to reduce the overall evaluation report writing time. • Responsible for assisting speech language pathologists with understanding the data requirements set by their client’s insurance company’s policy. • Meet with SLPs and other stakeholders to achieve best outcomes with a goal of reducing unnecessary time and anxiety for the ableEXPERIENCE process and identifying barriers to evaluation completion. • Collaborate proactively with internal departments to improve the SLP experience and facilitate best outcomes. • Meet with speech language pathologist during the ableEXPERIENCE to answer questions, review data collected and encourage completion of the speech evaluation. • Promote the utilization of AbleNet’s tools and resources to successfully improve insurance approval. • Address all inquiries with the utmost sense of urgency and quality of service. • Maintain HIPAA and FERPA laws in accordance with the compliance requirements of AbleNet. • Demonstrate the core AbleNet philosophies: Listen, Learn, and Lead. • Adhere to departmental procedures, processes, and workflows. • Follow and promote the department and corporate mottos (7 Rules of Engagements, 5S Methodology, and BE3).

• Searching for and proposing new investment targets via data-driven channels • Deal screening: call and/or meet with prospects, evaluate opportunities • Conducting analysis on company materials • Performing industry landscape evaluations • Conducting market sizing and competitor research • Building financial models to stress test unit economics

• Responsible for analyzing scientific and operational data to support the Data Surveillance process • Develops Data Surveillance Plans (DSPs) and conducts defined project reviews • Attends internal and external Data Surveillance meetings, presenting relevant findings to the project team • Reviews relevant data to support reviews designated for the DS Analyst per the project specific Data Surveillance Plan • Document findings from Data Surveillance activities in the DS Findings Form and other appropriate systems