Senior Payment Accuracy Analyst

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