Top 1 Senior coder Jobs in Pittsburgh Pa

Payment Accuracy Analyst, Senior - Hybrid
UPMC —Pittsburgh, PA
- $32.85 - $56.83 an hour
- Full-time
- Hybrid work
- Microsoft Access
- Mid-level
- Office
8d

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Payment Accuracy Analyst, Senior - Hybrid

UPMC -
Pittsburgh, PA

Apply Now

Job Details

Full-time
$32.85 - $56.83 an hour
8 days ago

Qualifications

Policy analysis

Full Job Description

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.

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.

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:

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.
Turn data into decisions: Analyze data, spot meaningful patterns, and translate those insights into clear guidance that drives action.

What We're Looking For

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.
Prior work experience in Claim Editing, Payment Integrity, or other healthcare claims operations-related fields is strongly preferred.

Nice-to-Have

Prior experience with clinical coding and/or medical record review.
Prior experience with policy research (CMS, PA State Medicaid, etc), interpretation, and source documentation.

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 skills

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Apply Now

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