Payment Optimization Support Specialist I

Payment Optimization Support Specialist I

UPMC has an exciting opportunity for a Payment Optimization Support Specialist I position in the Operations department. This is a full-time hybrid position based in the Pittsburgh area. While you'll primarily work remotely, you'll come into the office occasionally depending on departmental needs.

This role is responsible for the accurate retrieval, handling, and distribution of medical records and member documentation to support patient care, insurance processing, and legal requests. The position ensures that all medical record information is managed efficiently, securely, and in compliance with applicable regulations and organizational standards.

Responsibilities:

• Participate in training programs as assigned or requested to support continuous learning and development.
• Provide cross-functional support to other departments during periods of increased workload or backlog.
• Actively engage in team meetings by contributing ideas and suggestions to enhance client satisfaction and foster a collaborative work environment.
• Maintain strict confidentiality of employee and insured information in accordance with company policies and regulations.
• Work overtime as needed to meet business demands.
• Perform quality assurance checks on records prior to release to ensure completeness and compliance.
• Manage, organize, and upload extracted files in accordance with established procedures, including the ability to merge documents.
• Prioritize and complete assigned tasks efficiently and within designated timeframes.
• Release patient health information to authorized requestors in compliance with State and Federal regulations, as well as UPMC and Insurance Services Division (ISD) policies.
• Apply foundational knowledge of claims processing, terminology, and policy guidelines to support accurate review, appeal validation, and resolution efforts.
• Analyze claim history details to determine accuracy, identify trends, and assess potential discrepancies impacting appeal outcomes.

Qualifications:

• Associate's degree, or one year of equivalent experience in health care, health insurance, or a related field.
• Medical terminology and/or previous medical record experience required.
• Competent in MS Office and strong PC skills are preferred.
• Adobe Acrobat Pro experience preferred.
• Ability to demonstrate organizational, interpersonal, and communication skills.
• Maintain designated production and quality standards required.
• General knowledge HIPAA (Health Insurance Portability & Accountability Act).

Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran