Do you have nursing experience as an RN or LPN and healthcare billing and denial experience? UPMC is hiring a full-time Clinical Billing Specialist to support the Care Management department. This role works Monday through Friday during daylight hours and is eligible to work from home.
The Clinical Billing Specialist serves as a clinical resource for Patient Business Services areas, conducts charge audits, supports patient billing inquiries that require clinical review, and participates in the development of CQI initiatives.
Key responsibilities include:
- Appeal payer denials as requested
- Coordinate payor audits and conduct post-audit reviews
- Identify unbilled services and negotiate final outcomes with payors
- Communicate with physicians, office personnel, care managers, and payer review staff to expedite billing and accounts receivable processes
- Monitor and support process improvement initiatives to ensure regulatory compliance
- Perform CDM maintenance tasks
- Resolve charge issues and obtain pricing information from ancillary department managers
- Retrieve, review, and release medical records as needed
- Support policy changes related to new or innovative care approaches
- Assist in clearing claims for billing
- Respond to billing inquiries and complaints requiring clinical understanding
- Interpret third-party payor contract requirements and support compliance procedures
- Understand utilization management within the continuum of care
- Compare clinical findings with payor requirements and obtain supporting documentation
Requirements & Qualifications
- 5 years of varied nursing experience preferred
- Minimum of 3 years of experience in a healthcare financial environment preferred
- 2-5 years of patient account experience preferred
- B.S. degree in a healthcare-related field or Business Administration preferred
- Familiarity with Medipac and PC-based word processing, spreadsheet, and database software preferred
- Strong knowledge of CPT-4 and revenue coding preferred
- Knowledge of SI/IS criteria for commercial, Medicare, and Medicaid insurance products
- Act 34 clearance required
Location
Pittsburgh, Pennsylvania, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
1 week ago